The Regional Medical Director (RMD) works directly with assigned, regionally based, provider organizations to support the BSC mission of providing healthcare that is worthy of family and friends. RMDs work across all lines of business, with a particular focus on value-based provider partnerships such as HMOs, accountable care organizations (ACOs), Medicare Advantage and Medi-Cal contracts. RMDs are accountable for clinical and quality outcomes with assigned providers.
This position has a large field-based component, involving regular face-to-face meetings with strategic provider partners, and requiring outstanding communication skills. RMDs bring BSC initiatives to medical groups, IPAs, hospitals and other providers with the goal of improving care for BSC members. These clinical leaders also bring the provider perspective to BSC, improving collaboration. This position works cross-functionally at BSC, providing clinical, operational and strategic leadership for quality and affordability initiatives.
The RMD reports to a Senior Medical Director within the Provider Partnerships unit at BSC. The RMD will work closely with other provider-facing BSC leaders such as Senior Regional Leads and those within provider relations and contracting. This position has direct supervisory responsibilities, with at least two clinical program managers reporting into it. In addition, the position requires the ability to lead by influence and to collaborate across BSC, in close connection with the Chief Health Officer and Medical Care Solutions.
The ideal candidate will be an experienced physician leader with professional experience in both Health Plan and Provider Organizations. Strong communication and interpersonal skills are a must, as is the ability to analyze data, think quantitatively, and effectively message this analysis. Candidates should be passionate about value-based care, healthcare quality and equity. They should be innovative and results oriented.
- Build and maintain strong provider partnerships through alignment, shared goals and regular interaction; Engage key delivery system leaders to improve care delivery and reduce cost. Serve as an outward facing BSC professional, representing BSC to provider leadership (CEO, CMO level).
- Design and deploy provider-based and regional strategies that support BSC mission.
- Use data to help providers meet U.M and Quality targets.
- Work with multidisciplinary teams within Blue Shield to support design and implementation of key strategic programs. Lead cross functional teams when called upon. Partner with:
- Quality team to meet goals including HEDIS, Medicare Stars and hospital quality.
- Analytics and Cost of Healthcare team to meet affordability goals.
- Network management and provider relations to improve access to care and to deploy effective value-based payment.
- Innovation teams to provide clinical and practice expertise and execute on innovations.
- Medical Care Solutions to improve U.M and case management.
- Pharmacy teams on key initiatives.
- Lead BSC Initiatives and Chair committees when required.
- Assure compliance through direct involvement with delegation oversight process.
- When needed, help resolve escalated cases and issues from BSC, providers and members.
- Implement and improve strategies for complex patients, including CCM and Palliative Care.
- Work with BSC vendors such as Landmark and Gemini to support BSC mission and goals.
- Travel up to 25% of the time once safe from COVID 19 to do so.
Knowledge and Experience
- Active, unencumbered CA MD or DO License required
- Board Certified with 5 - 10 years direct patient care experience required
- Advanced degree in management, such as MBA, MPH or MPA preferred
- 5 – 10 years of direct patient care experience required
- 6+ years of experience managing and leading teams and coaching for performance required
- Subject matter expertise in the following areas required:
- Population Health
- Complex Care/Palliative Care
- Utilization Management
- Cost of Healthcare
- Delegation oversight
- Experience with Provider Group practices and operations
- Familiarity with Health Plan operations particularly medical management functions required; Experience working in a Health Plan setting preferred
- Value-based payment and delivery models, such as HMO, ACO, PCMH, bundled payments
- Excellent communication skills, both verbal and written
- Excellent analytical skills
- Project planning and project management skills
- Proficient with MS Office programs such as Microsoft Outlook, Excel, Word, PowerPoint, and Teams
- Proficient with Zoom
- Drives Focused Alignment and collaboration
- Gets sustainable results in the right way
- Continuously learns and improves
- Communicates effectively
- Skilled at change management
- Expereince with Medi-Cal preferred.
- About Company: At Blue Shield of California we are parents, leader, students, visionaries, heroes, and providers. Everyday we come together striving to fulfill our mission, to ensure all Californians have access to high-quality health care at a sustainably affordable price. For more than 80 years, Blue Shield of California has been dedicated to transforming health care by making it more accessible, cost-effective, and customer-centric. We are a not-for-profit, independent member of the Blue Cross Blue Shield Association with 6,800 employees, more than $20 billion in annual revenue and 4.3 million members. The company has contributed more than $500 million to Blue Shield of California Foundation since 2002 to have a positive impact on California communities. Blue Shield of California is headquartered in Oakland, California with 18 additional locations including Sacramento, Los Angeles, and San Diego. We’re excited to share Blue Shield of California has received awards and recognition for – LGBT diversity, quality improvement, most influential women in corporate America, Bay Area’s top companies in volunteering & giving, and one of the world’s most ethical companies. Here at Blue Shield of California, we’re striving to make a positive change across our industry and the communities we live in – Join us!
- Physical Requirements: Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork – Activity level: Sedentary, frequency most of work day.
Please click here for further physical requirement detail.
- EEO Footer: External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.