Senior Medical Director Care Management Position Available In [Unknown county], Florida

Senior Medical Director Care Management
FL, United States and 1 more (Remote)

JOB INFO

Job Identification
40737
Job Category
Medical
Posting Date
04/21/2025, 09:22 AM
Job Schedule
Full time
Job Shift
Day
Organization
FLORIDA BLUE, GuideWell
Locations
FL, United States
United States
(Remote)

JOB DESCRIPTION

The Senior Medical Director leads our Federal Employee Program (FEP) Medical Director team. You will be responsible for developing and implementing strategies, policies, and procedures to ensure high-quality care and service to FEP members. You will work closely with cross-functional teams, including network, quality, and analytics, to drive improvements in

HEDIS/CAHPS

measures, medical benefit costs, and overall program performance.

Key Responsibilities:

• Provide clinical leadership and expertise to the FEP network team on all provider engagement efforts that are directed at improving HEDIS quality performance while optimizing medical benefit costs of the FEP population. Work with analytics and network to review trends for provider performance and develop action plans for improvement
• Lead strategy of all

FEP HEDIS

member engagement efforts through pilots and/or initiatives directed at improving outcomes for the FEP PIP program scorecard, resulting in continued NCQA accreditation approval status and improvement of the annual QCR Plan Ranking year over year as evidenced in the annual Service Charge award

• Responsible for annually engaging physicians, provider groups and hospital systems as the FEP clinical lead to educate on and improve the

HEDIS/CAHPS

quality measures

• Provide clinical leadership for team members that support FEP to motivate and ensure employees align to the program’s scorecard for

HEDIS/CAHPS

quality and medical benefit cost improvement

• Manage the budget for the FEP Quality cost center for all areas/team members
• Operationalizing the interpretation and application data from the FEP Analytics team to strategically drive quality, utilization and financial improvements for the FEP program
• Provide clinical expertise and identify opportunities to continuously improve cost of care and medical benefit costs by working directly with the FEP Benefit Cost manager to improve the FEP scorecard
• Represent Florida Blue FEP as the clinical lead at workgroups, workshops and conferences to develop and cultivate collaborative relationships with other Plans as well as the FEP Directors Office (FEPDO) points of contact

Required:

• Current unrestricted Florida medical license as a Doctor of Medicine or Doctor of Osteopathic Medicine
• Board Certification by American Board of Medical Specialties or equivalent
• 5+ years of clinical experience
• Experience working with senior-level health plan executives, providers, and specialty societies
• Proven track record of improving business processes and procedures to maximize efficiency and achieve results
• Strong analytical and problem-solving skills, with ability to interpret data and make informed decisions

Preferred:

• Experience working with FEP and the Blue Cross Blue Shield Association
• Knowledge of NCQA, HEDIS and CAHPS measures
• Experience in clinical practice and medical administration, with a focus on managed care and FEP
• Experience with quality improvement initiatives and population health management
• Familiarity with healthcare delivery systems and market dynamics
  General Physical Demands
  Sedentary work: Exerting up to 10 pounds of force occasionally to move objects.

Jobs are sedentary if traversing activities are required only occasionally.

What We Offer:

As a Florida Blue employee, you will thrive in our Be Well, Work Well, GuideWell culture where being well as an individual, and working well as a team, are both important in serving our members and communities. To support your wellbeing, comprehensive benefits are offered. As an employee, you will have access to: Medical, dental, vision, life and global travel health insurance;
Income protection benefits: life insurance, short- and long-term disability programs;
Leave programs to support personal circumstances;
Retirement Savings Plan including employer match;
Paid time off, volunteer time off, 10 holidays and 2 well-being days;
Additional voluntary benefits available; and
A comprehensive wellness program
Employee benefits are designed to align with federal and state employment laws. Benefits may vary based on the state in which work is performed. Benefits for intern, part-time and seasonal employees may differ.
To support your financial wellbeing, we offer competitive pay as well as opportunities for incentive or commission compensation. We also conduct regular annual reviews with pay for performance considerations for base pay increases.

Annualized Salary Range:

$248,000 – $403,000

Typical Annualized Hiring Range:

$248,000 – $310,000
Final pay will be determined with consideration of market competitiveness, internal equity, and the job-related knowledge, skills, training, and experience you bring.
We are an Equal Employment Opportunity employer committed to cultivating a work experience where everyone feels like they belong and can perform at their best in pursuit of our mission. All qualified applicants will receive consideration for employment.