VP & Medical Director, Clinical Programs and Strategy

Permanent Position

SUMMARY

Blue Cross Blue Shield of Massachusetts (BCBSMA) seeks a Vice President & Medical Director, Clinical Programs and Strategy. The Vice President & Medical Director, Clinical Programs and Strategy (VPMD), is a senior physician leadership role in the Division of Health and Medical Management (HMM). This position will report to the Chief Physician Executive and be a member of the executive team which sets the strategy for achieving BCBSMA’s vision of quality, affordable healthcare. The Vice President & Medical Director, Clinical Programs and Strategy will involve substantial clinical program responsibilities that will guide medical policy and will have a significant role representing BCBSMA externally. This would include the National Blue Cross Association, state-wide agencies, media, employers, members, and providers. The successful physician leader will engage across the HMM Division to develop and maintain a full understanding of BCBSMA processes, policies and procedures. Additionally, the VPMD will work across disciplines and departments to consult with others for input to optimize BCBSMA’s efforts.

THE POSITION

Reporting to the Chief Physician Executive of BCBSMA, the Vice President & Medical Director, Clinical Programs and Strategy (VPMD) is a new role in the HMM Division that has program and policy responsibilities in HMM. The VPMD will need to collaborate across the organization for many initiatives. The VPMD will also have a major role interacting with external groups on a regional, state, and national level. S/he will be the HMM leader responsible for the directing the Medical Policy group, Clinical Quality and Compliance programs and the Clinical Pharmacy program. The VPMD has 2 direct reports and 7 FTEs in Medical Policy and 23 FTE in Quality and Compliance, Cost and Trend and an operating budget of $2.75M. Major Responsibilities:

• Serve as the physician leader of the clinical pharmacy and generate strategies to ensure the appropriate use of pharmaceuticals. The VPMD will Chair the Pharmacy and Therapeutics Committee.

• Provide direct oversight of the Medical Policy Department responsible for medical policy development and implementation.

• Serve as the physician leader of BCBSMA’s clinical Quality and Compliance programs and chair the Quality Program Committee.

• Serve as co-chair of the Trend Oversight Team which identifies initiatives and assesses their impact for presentation to the Medical Cost Council.

• Collaborate with the leadership of Performance Measurement & Improvement (PMI) in the ongoing development of high impact, clinically important measures for evaluating clinical quality, medical trend and efficacy of BCBSMA programs.

• Serve as the physician liaison to Provider Contracting and PMI to provide the necessary support for the effective development and negotiation of performance-based incentives in provider contracts.

• Serve as the liaison for HMM with the Corporate Strategy team.

• Serve as a clinical resource for Zaffre (BCBSMA’s investment arm) as Zaffre assesses potential investments and their clinical value.

• Serve as a clinical resource for divisions outside of Health and Medical Management as needed.

• Serve as the BCBSMA representative and physician lead: as liaison to the Massachusetts Medical Society and its associated specialty societies; the New England Health Plans and Medical Directors; and the National Blue Cross and Blue Shield Association.

• Represent BCBSMA at various external clinical meetings at a state-wide level with media, employer groups, consumers, and regulatory agencies.

• Collaborate with the BCBSMA’s Public Relations, Government Relations and Affairs, and Legal teams as they develop positions in response to market events and regulatory positions.

• Consult with Utilization Management and Case Management functions to ensure a full understanding of the breadth of Health and Medical Management.