MEDICAL DIRECTOR ACCOUNTABLE CARE PROGRAMS-SOUTHEAST
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The French Group has been exclusively retained to assist our client, a progressive and highly respected health plan, in hiring a physician executive for this newly created position.
The Medical Director, Accountable Care Programs will work closely with the team to deploy new collaborative, accountable provider relationships that recognize and reward improved quality and cost efficiency. This position will serve as a clinical liaison to physicians and hospitals throughout the transition to new payment and care delivery models which supports more coordinated, efficient and quality-driven healthcare. This Medical Director is responsible for providing the clinical expertise to internal staff that works closely with the providers and hospitals, as well as various areas throughout the Delivery System.
Entrepreneurial and innovative abilities are essential for this position to help enable the company to navigate through current change in the health care industry.
- Works with Network Programs Leadership Team to design, develop and implement alternative payment programs.
- Serves as clinical liaison to physician and hospital partners in accountable care programs including Accountable Provider Organizations, Patient-Centered Medical Homes, Accountable Specialty Care Programs, Bundled Payments, and Pay-for-Performance Programs.
- Serves as primary Florida Blue Medical Director for Gator Care and similar programs.
- Provides clinical guidance and leadership to Practice Transformation Specialists.
- Leads clinical quality component of work for accountable programs.
- Serves as internal liaison from Network Programs to Care and Utilization Management teams.
- Works with Care Management, Utilization Management and Medical Operations teams collaboratively to provide updates from network team and to maximize care programs where appropriate
- Provides clinical guidance and support to Network Contracting team.
- Provides clinical guidance and support to projects within Medical Cost Management.
- Works with organized medicine entities to support payment and delivery system transformation as well as the promotion of the programs within the medical community.
- Provides clinical guidance and leadership for the development and roll out of new ACO-based products and other high-performance network products.
- Collaborate in the expansion of Clinical Value Proposition for the Enterprise
- Maintain and develop relationships with key thought and business leaders in the health care delivery marketplace.
- Maintain and develop relationships with BCBS Association.
- Build trust by demonstrating high ethical standards and personal integrity and implement strategies aligned with Florida Blue’s mission.
KEY SELECTION CRITERIA:
- In-depth knowledge of health benefits industry, products, trends, consumer market, competitive intelligence, and legislative climate with a minimum of 5 years in a clinical administrative role. Deep understanding of the economic issues facing health care and the challenges facing a changing delivery system
- Working knowledge of physician and/or hospital based contracting, P4P programs and care management models (ACOs, medical homes)
- Ability to execute within a matrix management structure
- Innovative thinker with ability to drive program development
- Strong understanding and proficiency in use of metrics and measures in managing programs and services
- Skilled in negotiation and conflict resolution. Ability to influence others, accept alternative viewpoints and reach consensus when appropriate
- Ability to quickly and effectively execute plans and inspires motivation of others while encouraging appropriate risk taking and creative thinking
- Commitment to high service standards and a passion for making positive changes within the organization and the healthcare system
- Works collaboratively and encourages cross functional thinking
- Recognizes complexity of managing the needs of multiple customers (plan sponsors, members, providers, brokers and consultants) and proactively identifies those needs
- Highly organized and prioritizes multiple tasks with impeccable follow through
- Exceptional communication, listening and presentation skills
- Minimum of five years’ experience in direct patient care and highly regarded amongst medical community
- Ability to develop strong relationships both physician and hospital providers
- MD or DO degree from an accredited medical school
- License to practice medicine in the state of Florida without restriction, or ability to obtain.
- Current Board Certification in an ABMS/AOS recognized specialty
- MBA or MPH preferred
Tricia French RN, BSN
President & CEO
The French Group