Senior Medical Director Job in Wellesley, Massachusetts Us
Who we are
Harvard Pilgrim is a not-for-profit health plan and a full-service benefits company serving members in Massachusetts, New Hampshire, Maine and beyond. We make health care work better. We recognize diversity's impact and importance for our workforce, customers and providers, and through our contributions to the communities we serve. It's part of the way we do business.
What we value
Harvard Pilgrim believes that greatness is built from the inside out. It's created by individuals who share common goals, and who support and rely on one another to achieve them. Our core values guide us in how we treat, respond to and interact with our customers, business partners and one another.
Who we hire
We hire the best and brightest-talented individuals who value innovation, creativity and communication in the workplace. Harvard Pilgrim believes that by attracting, retaining and engaging diversetalent, we gain a sustained competitive advantage for continued growth.
Our employees bring Harvard Pilgrim's mission, values and brand to life in an inclusive and supportive environment where they are respected and valued for their contributions. Being part of the Harvard Pilgrim team means that you excel at what you do. You're dedicated to your work and continually look for new ways to serve your customers better.
What we offer
We do our best to support our employees in making the most of their lives both inside and outside of work. At Harvard Pilgrim, we know that a talented, engaged and inclusive workforce is our greatest strength. We have an excellent benefit package and are "T" accessible.Some of our benefits include:
* A comprehensive work and life benefits program, including medical and dental benefits, time away from work, retirement, financial protection and on-site fitness centers.
* Opportunities to learn and grow, build relationships, share your opinions and do what you do best every day.
* Ways to serve and give back to the communities where you live, work and play - through grants, fundraising and volunteering.
JOB SUMMARY:
The Senior Medical Director reports directly to the Chief Medical Officer and has accountability for staff medical directors and their direct reports. This individual will have direct accountability for the development and execution of new emerging care delivery models, such as medical home, bundled payments, etc. He/she will act as clinical leader for the development, implementation and assessment of pay-for-performance and provider incentive programs. The Sr. Medical Director will be expected to provide strategic oversight of senior leadership, including Utilization Management, Network Medical Management, and Pharmacy functions. This individual will also support cross-functional business area leaders, and represent the CMO and/or his Chief of Staff at meetings and on committees, as appropriate.
ESSENTIAL FUNCTIONS:
- Lead and manage performance of clinical policy, clinical review, utilization management, pharmacy and network medical management functions, with a strong focus on execution of strategic initiatives.
- Build out emerging care delivery models, such as medical home and implement within network practices.
- Build relationships with clinical leadership of key provider organizations.
- Ensure all initiatives have built-in measurement and data sharing that demonstrates success and ROI.
- Review, recommend and implement interventions intended to improve quality and decrease cost.
- Influence the design and coordination of measurement activities associated with clinical initiatives, network performance, and CMS Quality Assessment.
- Oversee development, management and evolution of network pay-for-performance programs and the Quality Grant Program.
- Support provider network initiatives, such as provider tiering and other transparency approaches.
- Serve on key internal committees such as Payment Policy, Medical Trend, and Provider Medical Cost.
- Oversee the design and implementation of health improvement strategies and support disease management and population health initiatives throughout HPHCs network and membership.
- Support CMO, government relations staff and others on matters of "public" clinical policy.
- Represents HPHC, as needed, in external forums, at direction of CMO.
- May represent CMO at key meetings when CMO is unavailable.
-
Graduation from an accredited school of medicine. MBA or other advanced degree desirable.
-
Licensed to practice medicine in Massachusetts without restriction.
-
Board certification required.
-
5 years clinical experience.
-
8-15years medical management.
-
Excellent communication, leadership and management skills.
-
Experience with pay for performance preferred.
-
Excellent relationship management
-
Ability to lead and manage cross functional teams
-
Experience with provider negotiation and performance management
-
Proven ability to manage multiple projects and large number of staff
-
Proven ability as decision-maker and leader around corporate priorities
If you'd like to join Harvard Pilgrim, we'd like to hear from you!
Please visit www.harvardpilgrim.org to set up a job agent.
Harvard Pilgrim supports individuals in reaching their full potential by supporting equal employment opportunities and an environment that actively values diversity and inclusion. Harvard Pilgrim complies with all applicable laws concerning hiring and employment practices and is firmly committed to fostering and maintaining a workplace free from discrimination. We pledge to hire, train, and promote our employees without regard to race, religion, gender, gender identity, age, national origin, sexual orientation, disability, veteran status or any other category protected by applicable law.
