Vice President, Chief Medical Officer

2 days ago

Baltimore, Maryland, United States CareFirst BlueCross BlueShield Full time
Job Summary

CareFirst BlueCross BlueShield seeks a seasoned clinical leader to drive excellence in healthcare affordability, quality, and member experience. As Vice President and Chief Medical Officer, you will lead the organization's efforts to achieve excellence in healthcare affordability, quality, member experience, and improved population and member outcomes in both commercial and government program lines of business.

Key Responsibilities:

  • Leads the organization's efforts to achieve excellence in healthcare affordability, quality, member experience, and improved population and member outcomes in both commercial and government program lines of business.
  • Drives the company-wide Quality Management program, including CMS Stars and risk adjustment, and the ongoing development and implementation of health care policy and technology assessment.
  • Provides medical oversight and expertise in appropriateness and medical necessity of healthcare services provided to Plan members, targeting improvements in efficiency and satisfaction for members and providers.
  • Serves as a clinical advisor/leader for teams dedicated to concurrent review, prior authorization, case management, disease management, and clinical coverage review.
  • Represents CareFirst in state and local level workgroups, task forces, and committees that address medical quality and cost.

Requirements

  • Medical Degree in primary care specialty from an accredited medical school and an American residency in a primary care specialty.
  • Current medical license in the State of Maryland (or credentials to apply for and be granted a Maryland license).
  • Board certification.
  • Minimum of 8 years clinical and administrative experience in a managed care setting.
  • Previous experience as medical director for a healthcare company.
  • At least 5 years as a leader of people and teams.

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