Vice President, Medical Management/Medical Directo
The Vice President, Medical Director reports directly to the President, BCBS Georgia with a dotted line relationship to the SVP, Regional Health Care Management.
This position is responsible for delivery of high quality, customer responsive, and cost effective care for members through utilization, quality, and service management, and coordination with provider network contracting and actuarial.
Other essential duties include, but are not limited to:
Provides strategic guidance and develops medical programs to ensure strategies for provider development, partnerships, and outcomes management are met on an ongoing basis to effectively deliver healthcare products which meet utilization and financial objectives, as well as ensure increased market share.
Participates in the development of network reimbursement strategies, evaluation of contracting options and assessment of outcomes related to network strategy.
Ensures relations with physicians, hospitals, and other provider communities are proactive, positive, and open.
Provides oversight and coordination to the credentialing and recredentialing of all providers in the network in concert with the Enterprise model.
Directs the medical management programs and coordinates the development of case management, utilization management, advanced care management, and effective disease management programs to meet the needs of the member population.
Provides leadership to all Medical Directors and Associate Medical Directors relative to industry trends and consistency of application of medical and quality programs throughout the BCBSGa business.
Will be a member of the Senior Leadership Team and represent BCBSGa at enterprise-wide initiatives in coordination with SVP, Regional HCM.
MD with extensive managed care knowledge required. 10 years of increasingly responsible professional experience required. Disease Management programs experience preferred. Advanced written, oral and interpersonal communication skills required. Advanced analytical and problem-solving skills required. Excellent computer skills required. Excellent tactical planning and organizational skills required. Proven managerial, leadership and project management skills required.
Please apply to position number 09696 by visiting www.WellPoint.com or e-mail your CV to Kelly.Suter@Anthem.com