Blue Cross North Carolina is deploying a comprehensive strategy to increase access to effective behavioral health care. We are integrating behavioral health treatment within primary care; transitioning to value-based reimbursement models that incentivize quality and access; and incorporating telehealth and digital platforms to expand capacity. This behavioral health strategy is part of our overall transition to Blue Premier ACOs across North Carolina. Come work with us to help lead this change!. The Medical Director brings a unique set of knowledge and skills to the business of Blue Cross North Carolina and frequently serves as an interface between the company and physicians, providers, employer and community groups, and members as needed. This role utilizes clinical knowledge and experience to support value-based strategies, clinical operations and our organizational pursuit of high quality and cost-effective care for members.. Leadership Skills:. Clinical leadership for behavioral health strategic initiatives and care management. Project planning and management. Strategy:. Develops, collaborates and/or drives strategy and approach for behavioral health.. Engages behavioral health providers in quality measurement and quality improvement.. Communicates with providers and health systems to increase adoption of integrated behavioral health and primary care.. Provides clinical oversight of programs within the overall behavioral health strategy at Blue Cross North Carolina.. Communicates and supports delivery of alternative payment models for behavioral health.. Develops innovative methods to support Blue Cross NC member engagement in behavioral health care.. Operations:. Develops and provides oversight of behavioral health medical policy and reimbursement.. Care management (utilization management, case management, PA, appeals, grievances). Educates and interacts with network and group providers and medical managers regarding utilization practices, guideline usage, pharmacy utilization and effective resource management.. Facilitates conformance to Medicare, Medicaid, NCQA and other regulatory requirements.. Healthcare programs (alternative payment models, supporting providers to deliver integrated care). Behavioral health network support (Communication, credentialing, quality reporting). Partnership:. Develop strategic partnerships with internal business partners and external clients and providers to support value based agreements and drive better consumer and provider experience.. Takes a lead role in outreach and relationship building across the community (i.e. providers, health systems, community partners, members, etc).. Evaluate and manage new and/or existing vendors and solution partners to align to BCNC's strategic direction. Ongoing provider engagement functions. Data gathering, management and analysis:. Evaluate clinical and other data to identify opportunities for improvement in health outcomes and financial performance. Discuss data and performance with providers, employers, accreditors and regulators as needed.. Communications:. Represent BCNC through delivery of presentations, speaking engagements and leadership of advisory groups with external audiences related to health care transformation and BCNC's initiatives.. Publish high impact content focused on improving accessibility, quality and affordability.. Innovation:. Payment model design. Identify market trends that should influence key investments (new technologies, best practices).. Evaluation of investment/partnership opportunities. Education/Experience Requirements:. MD or DO from an accredited medical school. Completion of residency training program in ABMS/AOA recognized clinical specialty.. 5 years of clinical experience following the completion of a residency program is required.. Some relevant experience outside of clinical practice is also required (i.e. private or government health plan, consulting house, academic roles, employee health programs, regulatory agency at state or federal level, etc.). For some roles related to operational functions, a current North Carolina medical license is required. Associated topics: alumni, chief marketing officer, cmo, demand, donor, event, lead generation, presale, principle gift, relation
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