What are the responsibilities and job description for the Medical Director, Line of Business position at Blue Shield of California?

Your Role

The Medical Director, Line of Business is dedicated to supporting the clinical operations, performance, and growth of the California Public Employees’ Retirement System (CalPERS) business. CalPERS is the nation’s largest public pension system and the second largest public purchaser of health benefits in the nation. The role also includes strategic healthcare cost management oversight for the business, driving strategies to lower the cost of care while increasing engagement and improving the quality of care for the members. This position will report to the Senior Medical Director, Line of Business.

Your Work

In this role, you will :

Represent Blue Shield of California (BSC) as the clinical lead for the CalPERS account, supporting both clinical and business objectives
Work collaboratively with other Health Solutions and BSC staff to quickly resolve employer service issues, with particular emphasis on clinical issues. Be available to talk with key account members and employers about their issues and the solutions
Lead employer and other external-facing activities, including finalist presentations and account services meetings. Guide and participate in the preparation of relevant client meetings
Responsible for the planning, development, and lead the delivery of Health Solutions-related materials to CalPERS and relevant vendors / partners that describe and explain the operational details and value of Health Solutions capabilities, services, and programs. Including working with the Health Data Reporting teams to analyze data trends and develop external customer reports
Support enhancements to reporting capabilities and processes for effectively delivering clinical performance and health plan management
Serve as a strategic thought partner for Health Care Services to develop best in class health management capabilities and help with designing and implementing some of the innovations to address the market needs

Your Knowledge and Experience

Medical degree (M.D. / D.O.) required

Active, unrestricted California State Medical License required

10 years managed care experience is required

5 years clinical experience is required

Completed residency preferably in adult based primary care specialty (e.g. internal medicine, family practice)

California managed care marketplace experience required

Previous experience required in national, complex account management support

Demonstrated commitment to delivering exceptional client experience

Excellent verbal and written communication skills, including ability to speak comfortably and extemporaneously to diverse audiences

Ability to explain program, clinical, operational, and quantitative information in a business-like, clear, coherent, and comprehensible way to multiple levels of audience types

Strong quantitative and analytical skills working with claims, operational, and clinical data and reports

Excellent interpersonal communication skills, including active listening, self-management and awareness, emotional intelligence, and ability to flex interpersonal style

Ability to model a collaborative approach with internal and external stakeholders

Strong negotiation and creative problem-solving skills

Strong skills with Microsoft Office Suite, including PowerPoint, Excel, Word, and Outlook

Pay Range :

The pay range for this role is : $230,010.00 to $330,000.00 for California.

Note :

Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.

LI-JS3

Salary : $230,010 - $330,000

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Medical Director, Line of Business

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