VP, Chief Medical Officer, Medicare
 Blue Shield of CA | |
 United States, California, San Diego | |
 Mar 17, 2025 | |
|
Your Role The VP, CMO, Medicare is accountable for providing medical oversight, expertise and leadership to ensure the delivery of affordable, quality healthcare services across all Medicare product lines (Individual, Group, PPO). The role requires strong partnerships with the General Manager of the Medicare team, the Quality team, the Encounter team, and Network Management and as applicable other cross-functional leaders/team who impact Medicare performance, and will require a deep connection and "oversight" of the UM and CM teams within BSC. In addition, the work can only be successful in close collaboration with the delivery system partners who are delegated for certain clinical and administrative functions. As such, the VP CMO, Medicare will need to have strong skills in influencing, leading by example to establish, maintain and support provider partnerships, with insights and experiences in both health plan and delivery system infrastructure. The VP CMO, Medicare will think strategically, have strong leadership and management skills, and be distinguished for the ability to achieve results and quality outcomes. The ideal candidate will have a successful track record of clinical oversight and outcome based performance, understand critical components of accurate and timely submission of risk scores through encounter data, Medicare revenue and costs related to utilization management, case management, pharmacy management, Medicare Stars experience, general health plan knowledge and firsthand experience implementing clinical programs into delivery systems, and facilitation of good working relationships and management of IPA's, medical groups and integrated health systems. Your Knowledge and Experience
| |