Vice President of Medical Operations Health and Medical Management

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Blue Cross Blue Shield of Massachusetts | Boston, MA

Permanent Position

SUMMARY

Blue Cross Blue Shield of Massachusetts (BCBSMA) seeks a Vice President of Medical Operations. The Vice President of Medical Operations Health and Medical Management (VPMO) 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 is a member of the executive team that sets the strategy for achieving BCBSMA’s vision of quality, affordable healthcare. The Vice President of Medical Operations will involve substantial clinical program responsibilities and will partner with the Vice President of Clinical Operations. The Vice President of Medical Operations is responsible for Utilization Management and Care Management and the development of innovative programs to improve the quality of care in ways that also reduce medical expenses. BCBSMA has led initiatives in this area that are now replicated across the country. The VPMO  will lead current programs, while seeking initiatives that will affect and improve the population health of its members. The VPMO  will work across disciplines and departments and seek opportunities externally to optimize BCBSMA’s efforts.

THE OPPORTUNITY

The Vice President of Medical Operations is one of five senior physicians in Health and Medical Management Division (HMM), who are direct reports to the Chief Physician Executive. The Vice President of Clinical Operations, the VPMO’s dyad partner is a nursing leader who reports to the Chief Physician Executive and is a peer of the Medical Directors. The Division is the nexus of all medical operations and policy dialogue. The Division has 445 Associates, 225 clinical staff and 220 non-clinical staff and a budget of $42M.

THE POSITION

Reporting to the Senior Vice President, Chief Physician Executive, the VPMO is responsible for the professional oversight and physician leadership of all medical management programs in support of the corporate goal of providing access to high-quality, affordable health care for members. The VPMO has five direct reports, three physician leaders and two nursing leaders and for a total of 45 FTE’s in Medical Operations. The VPMO team includes operational oversight of the Provider Appeal Unit, Corporate Peer Review, and clinical oversight of Provider Credentialing. He/She will have direct line responsibility for and will mentor the Associate Medical Directors of the Medical Surgical PRU, the Behavioral Health Physician / Psychologist Review unit, and the Physician Clinical Consultant for Care Management.   In partnership with the Vice President of Clinical Operations, the VPMO is responsible for the implementation and successful execution of Utilization Management and Care Management Services. This would include monitoring trends in utilization, developing strategies to mitigate their escalation, and participating in the evaluation process assessing utilization management and medical policy review workflows for their efficiency and effectiveness. A priority goal is to analyze work flow in the unit and the interdependencies with Clinical Operations to create lean focused and efficient evaluations, while reducing rework so resources can be deployed to create innovative initiatives that will optimize the opportunities to improve population health for members.   As a key physician leader within Health and Medical Management, the role will provide support to our Sales teams with on-site visits to specific accounts on an as needed basis. The VPMO will also represent BCBSMA in strategic initiatives with the provider community.   Working as a cross-functional member of the Health and Medical Management Team, the successful candidate will be quality-focused, innovative and will champion process improvement. He/She will foster a positive and effective working relationship with key external and internal customers. The Vice President will maintain close and effective relationships with key areas of the company necessary to the development and integration of case and utilization management activities. The Vice President is responsible for ensuring that clinical decisions related to BCBSMA’s health care services are administered in a manner that offers superior quality, maximizes cost effectiveness and is consistent with BCBSMA medical policies.

Vice President of Medical Operations Health and Medical Management

For More Information

Referrals, nominations, applications and confidential inquiries are welcome. For additional questions, please contact Ellen Mahoney or Jacqueline Rosenthal at 781.938.1975. All contact with ZurickDavis will remain confidential.

Apply Now

We welcome nominations and referrals of prospective candidates. Interested parties, please send resume and cover letter to BCBSMAVPMO2271@ZurickDavis.com.

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