At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers.
Join HCSC and be part of a purpose-driven company that will invest in your professional development.
This position is responsible for planning and implementation of medical policies and programs and strategic involvement with the cost of health care for accounts with more than 800,000 federal employee members across 5 states. This position is primarily accountable for advising and implementing quality improvement initiatives, medical guidelines, management of high-cost claimants, 2nd level prior authorization and claim reviews and process improvements. In addition, to various degrees, this position will perform physician level review using applicable systems and maintain effective relationships with physicians, hospitals, and medical service companies to respond to and resolve problems, serving as the final decision maker for clinical determination. This position will also head projects to promote effective policy relative to the membership of the Federal Employee Program in partnership with the Blue Cross Blue Shield Association. Please note, this is a HYBRID position which requires in-office hours 3 times a week at the respective location.

JOB REQUIREMENTS:

• Physician (M.D. or D.O) with a current and unrestricted physician license in a state or territory of the United States
• Maintain Board Certification by a specialty board approved by the American Board of Medical Specialties, National Board of Physicians and Surgeons, or the Advisory Board of Osteopathic Specialists
• 5 years of post-graduate patient care/clinical experience.
• 5 years of managed care experience coupled with proven experience in the application of medical problems to managed care practices.
• Knowledge of current medical and surgical techniques, reimbursement methodology, and benefit management.
• Leadership skills to lead groups to consensus and resolution building aligned to corporate strategy
• Demonstrated ability to independently make tough strategic decisions and move forward with actions on the strategies.
• Strong verbal and written communication skills.
• Experience achieving results through people.
• Experience being proactive and highly results oriented; able to meet deadlines under pressure.
• Experience thinking innovatively and developing process improvements to align with business strategies.
• Experience being the subject matter expert/leader in a specified field.
• Experience presenting and negotiating.
• Strategic thinking skills.
• Proficiency in computer use (including software applications such as Microsoft Office Products) needed for electronic documentation of case reviews
• Overseeing the annual budget and allocating resources for various projects and operational needs.
• Translating needs and initiatives into compelling business cases.
• Conducting cost-benefit analyses to justify investments and ensure ROI.

PREFERRED EXPERIENCE:

• Experience developing business strategies, leading broad medical policy initiatives.
• Proficient in data analytics and reporting, including the capability to collaborate and direct analysts with novel queries.
  

  LI-Hybrid

LI-AZ1

Compensation: $210,600.00 - $391,100.00
Exact compensation may vary based on skills, experience, and location

Please refer the Job description for details