The Chief Medical Officer for Blue Care Network leads a team that delivers an enterprise multi-platform medical case management strategy. Also ensures appropriate utilization and deploys innovative population health programs for BCN members.

• In partnership with the BCBSM Chief Medical Officer, will serve as a spokesperson and advocate for Blue Care Network on HMO medical policy and clinical issues.


• Will work in partnership with the President, BCN to serve as Blue Care Network’s primary clinical interface with other external stakeholder groups including employers, community coalitions and regional and national associations on HMO medical policies and programs. 


• In collaboration with BCBSM, will provide leadership and oversight for medical management programs including establishment of medical management policies, procedures, protocols and systems to support and promote the appropriate and cost-effective use of clinical resources.


• Work in collaboration with BCBSM teams to provide oversight for BCN clinical editing decisions and outcomes.


• Develop professional fee schedule development and enhancements.


• Provide input for all quality management and quality improvement programs including establishment of policies, procedures, protocols and systems to support and promote the consistent delivery of high-quality medical care and optimization of member health.


• Provide input for health and wellness programs, case management programs, disease management programs, utilization management programs, program quality and support, clinical program innovation, customer group consulting and WCM program administration and governance


• Ensure compliance with legal requirements and regulatory/accrediting agencies’ standards and procedures through the oversight of regulatory (e.g., State of Michigan) and accreditation (e.g., NCQA) reviews related to utilization and quality management.


• Provide input and direction in the development of clinically and cost-effective programs that improve member access, enhance customer satisfaction, lower medical costs and maximize positive health outcomes.


• Work closely with our pharmacy team to establish policies, procedures and protocols to support the appropriate and cost-effective use of pharmaceuticals.


• Provide assistance and support for provider relations, network development and provider contracting activities including strengthening of provider communications, improving clinical linkages and relationships with network providers, and developing an accountable high-quality and committed provider network with aligned incentives.


• Provide input for the corporation’s medical data capture, analysis and reporting activities.
  
  Provide input for development of benchmarking data/standards, evaluation mechanisms, outcome measurements and clinical systems innovations.


• Provide input for the common strategy for physician incentive program for Medicare Advantage-PPO and BCN Advantage.


• Provide oversight for Medicare Advantage medical policy.

• Doctor of Medicine or Doctor of Osteopathic Medicine.


• Masters in Business Administration, Masters in Health Services Administration, or equivalent highly preferred.


• Minimum of ten (10) years of leadership experience in health care administration.


• Minimum of ten years direct clinical patient care experience.


• Active, unrestricted Michigan medical license. 


• Active certification by a member board of the American Board of Medical Specialties (ABMS).


• In-depth knowledge and experience in hospital systems and provider systems.


• Knowledge of the insurance industry and issues impacting health care costs.


• Ability to frame and structure problems, discern critical issues, and drive solutions.


• Ability to build internal capabilities and assemble a supporting management team.


• Excellent written and verbal communication and presentation skills.  


• Strong negotiation skills and decision-making ability.

All qualified applicants will receive consideration for employment without regard to, among other grounds, race, color, religion, sex, national origin, sexual orientation, age, gender identity, protected veteran status or status as an individual with a disability.