BlueCross BlueShield of Tennessee is seeking an experienced healthcare leader to join us as Vice President and Chief Medical Officer on our Senior Products team. In this role, you will chart the course for our clinical organization and act as the clinical voice reporting to the line of business leader, ensuring that that our clinical programs support our strategic vision.
You will be an ideal match for this role if you have had experience as a Lead Medical Director or Chief Medical Officer in a Medicare Advantage program. Knowledge and/or experience in the following areas is strongly preferred:
Implementing clinical management programs to address utilization and cost trends, with a proven track record of lowering costs.
Evaluating program effectiveness and identifying opportunities for increased efficiency.
Navigating CMS regulations and leading a response to a CMS program audit.
Job Responsibilities
- Establish and implement standards and policies to promote quality of medical care and services provided to members, and to assure accreditation.
- Provide leadership in the provider community including interacting with medical societies and peer groups and educating providers regarding identified problems or issues.
- Establish, implement and maintain an inter-reviewer reliability methodology to ensure medical necessity determinations are consistent with appropriate governmental or corporate medical review criteria, medical guidelines and medical policy. Serve as clinical executive leader relating to the appropriate government line of business.
- Lead and serve on various committees in order to accomplish medical utilization, cost and quality objectives of BCBST.
- Implement and oversee required quality and accreditation programs necessary for the specific line of business.
Job Qualifications
Education
- Unrestricted Tennessee medical license and board certification in a specialty recognized by the American Board of Medical Specialties or the America Board of Osteopathic Specialists
Experience
- 5 years - Clinical experience required
- 5 year - Experience as a Medical Director in a risk based managed care program and in-depth knowledge of medicine required
- 7 years - Healthcare administration, including UM experience required
Skills\Certifications
- Proficient in Microsoft Office (Outlook, Word, Excel and PowerPoint)
- Excellent oral and written communication skills
- Strong interpersonal and organizational skills
- Ability to interpret and explain complex government policies
Preference will be given to candidates with knowledge of/experience with Medicare Advantage.
Employees who are required to operate either a BCBST-owned vehicle or a personal or rental vehicle for company business on a routine basis* will be automatically enrolled into the BCBST Driver Safety Program. The employee will also be required to adhere to the guidelines set forth through the program. This includes, maintaining a valid driver’s license, auto insurance compliance with minimum liability requirements; as defined in the “Use of Non BCBST-Owned Vehicle” Policy (for employees driving personal or rental vehicles only); and maintaining an acceptable motor vehicle record (MVR). *The definition for "routine basis" is defined as daily, weekly or at regularly schedule times.
Number of Openings Available:
1
Worker Type:
Employee
Company:
BCBST BlueCross BlueShield of Tennessee, Inc.
Applying for this job indicates your acknowledgement and understanding of the following statements:
BCBST is an Equal Opportunity employer (EEO), and all employees and applicants will be entitled to equal employment opportunities when employment decisions are made. BCBST will take affirmative action to recruit, hire, train and promote individuals in all job classifications without regard to race, religion, color, age, sex, national origin, citizenship, pregnancy, veteran status, sexual orientation, physical or mental disability, gender identity, or any other characteristic protected by applicable law.
Further information regarding BCBST’s EEO Policies/Notices may be found by reviewing the following page:
BCBST’s EEO Policies/Notices
BlueCross BlueShield of Tennessee is not accepting unsolicited assistance from search firms for this employment opportunity. All resumes submitted by search firms to any employee at BlueCross BlueShield of Tennessee via-email, the Internet or any other method without a valid, written Direct Placement Agreement in place for this position from BlueCross BlueShield of Tennessee HR/Talent Acquisition will not be considered. No fee will be paid in the event the applicant is hired by BlueCross BlueShield of Tennessee as a result of the referral or through other means.
Tobacco-Free Hiring Statement
To further our mission of peace of mind through better health, effective 2017, BlueCross BlueShield of Tennessee and its subsidiaries no longer hire individuals who use tobacco or nicotine products (including but not limited to cigarettes, cigars, pipe tobacco, snuff, chewing tobacco, gum, patch, lozenges and electronic or smokeless cigarettes) in any form in Tennessee and where state law permits. A tobacco or nicotine free hiring practice is part of an effort to combat serious diseases, as well as to promote health and wellness for our employees and our community. All offers of employment will be contingent upon passing a background check which includes an illegal drug and tobacco/nicotine test.An individual whose post offer screening result is positive for illegal drugs or tobacco/nicotine and/or whose background check is verified to be unsatisfactory, will be disqualified from employment, the job offer will be withdrawn, and they may be disqualified from applying for employment for six (6) months from the date of the post offer screening results.
Resources to help individuals discontinue the use of tobacco/nicotine products include smokefree.gov or 1-800-QUIT-NOW.
