Chief Medical Officer
Bcidaho

Blue Cross of Idaho (BCI) is uniquely positioned as a well-capitalized, leading healthcare payer in its market, serving hundreds of thousands of Idahoans and partnering with premier employers across the state.

Reporting to the President, Health Markets, the Chief Medical Officer (CMO) serves as the point of contact for clinical strategies and policies to reduce healthcare delivery costs and improve effectiveness, efficiency and quality of medical management by BCI and provider systems of care. This role will foster cooperative and mutually beneficial relationships with physician and care delivery providers in the health care community that facilitate the necessary effectiveness and expansion of care. The CMO will advise and lead a team of medical experts on relevant matters of public health importance, locally and nationally.

This position is located at the corporate headquarters in Meridian, Idaho and will be required to have or obtain an Idaho Medical license.

To be considered for this role, you have:

Required Experience:

• Ten years in direct patient care in clinical practice
  
• Minimum of eight years health plan managed care (either with a medical group or health plan) utilization management, health care quality improvement (such as NCQA, CMS), and in the development and implementation of clinical practice guidelines and policy at a senior level
  

Required Education:

• Doctorate Degree in Medicine
  

Required Certifications/Licenses:

• Current unrestricted medical license - either Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO)
  
• Board certified in medical specialty
  
• Ability to obtain an Idaho Medical license
  

We'd also love it if you had:

• Experience in medical administration, and active participation in local, state, and national medical associations
  
• Master of Business Administration (MBA) or equivalent discipline
  

Key Responsibilities of the role:

• Create strategic opportunities for the optimization of healthcare resources while operating within the constraints of the delivery system, cost, and legislative limitations
  
• Build partnerships in new and existing markets and establish and maintain relationships with key clients and political/community leaders
  
• Support collaborative relationships with physicians, other provider types and hospitals that advances BCI's objectives. Steer change initiatives and guide collaborative efforts between key players. Act as a liaison with health service professionals as a member of the Executive Staff, representing the company at professional organizations
  
• Provide direction to the Provider and Hospital contract function as it affects healthcare systems strategy. Collaborate with Provider Services to establish reimbursement strategies, including but not limited to, quality incentives and pay for performance
  
• With Provider Services and Medical Quality Management (MQM) leadership jointly review provider practices patterns, (e.g., overuse, under use, and misuse of services, excessive fees, sub-optimal care, or fraud) on a systems level to find variances, outlier performances and trends that will necessitate any alteration in the strategy
  
• Work effectively with Providers and delivery systems to ensure the delivery on the promise of effectively integrating our BCI capabilities and services, to achieve more effective care, higher quality and engagement of our members, and efficient use of service delivery systems
  
• Work effectively with MQM to develop policies and strategies that improve medical expense cost, quality, system effectiveness and efficiencies of care
  
• Assure quality of care for BCI members and provide guidance and direction of disease state and case management. Focus on defining and ensuring high value support and the best possible patient experience
  
• Develop clinical innovations and ensure clinical excellence in BCI's practice
  
• Define and drive corporate focus on clinical technology and healthcare. Develop the strategic business planning and clinical technology solutions for medical quality management
  
• Identify, and where necessary, help develop a high-performance provider designation, and where appropriate, centers of excellence for complex medical challenges
  
• Effectively communicate to the President/CEO, board, and other constituents on progress of key initiatives and strategic planning
  
• Provide strategic direction for the quality management activities to achieve the necessary deliverables for BCI including but not limited to improvement in STARs rating, NCQA accreditation and other demonstrations of quality
  
• Consult on medical policy statements for major policy decisions. Establish and maintain the medical policy for the Corporation
  
• Provide guidance and direction to the Medical Directors in the development of cost, utilization, and medical review strategy and activities
  
• Support internal functions such as payment integrity and special investigations to provide clinical expertise and guidance
  
• Serve as the senior medical consultant in all areas of the Company's operation; keeping the President/CEO and executive staff fully informed of internal and external medical affairs that impact the Company
  
• Maintain current knowledge of state and federal procedures, practices, and medical methodologies through study, attendance at professional meetings, seminars, and consultation with other physicians
  
• Promote cross functional teamwork, discussion, and cooperation among staff and other departments. Ensure timely communication and sharing of information with team members. Participate in training, coaching and motivation of employees including career path development.
  
• Perform other duties as requested
  

To be successful in this position, you have:

• Strong interpersonal skills to effectively collaborate with internal/external providers, senior management, and Board of Directors.
  
• Ability to cultivate networks with people from across a variety of business units, operational functions, and locations.
  
• Transparent leader with high integrity. Strong people leader and developer of talent. Strong management, relationship building, and communication skills.
  
• Poise and the ability to act calmly and competently in high-pressure, high-stress situations.
  
• Able to properly translate clinical policy and program details into business terms for Executive leadership.
  

Reasonable accommodations

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed above are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.

This job has expired.