Vice President, Medical Management/Medical Directo
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.
Ensures medically appropriate programs and contracts are secured for all products.
Provides assistance with sales and retention of business and provides oversight and management of all disease management programs.
Provides strategic guidance and develops medical and quality care 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.
Ensures relations with physician, hospital and other provider communities regarding medical management issues 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 local quality management programs which include health care delivery, medical records, pharmacy and physician assessment, member satisfaction, risk management, and claims review.
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 BCBSVa business.
MD with extensive managed care or Medicare knowledge required. 10 years of increasingly responsible professional experience required. 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 job number 09878 by visiting http://careers.anthem.com or send your CV to Kelly.Suter@Anthem.com