The Medical Director will support Well Sense Health Plan (WSHP) in New Hampshire in aspects of clinical program development and execution. S/he will serve as the primary clinical contact for Well Sense, providing day-to-day coordination of the Well Sense staff of the Office of Clinical Affairs (OCA) in areas of medical management including care management and population management, utilization management, quality, and pharmacy management. Represents the Office of Clinical Affairs in developing and maintaining relationships with governmental organizations, regulatory groups, healthcare providers, and other external stakeholders. Maintains dual reporting relationships to the Chief Clinical Officer (CMO) and Executive Director of WSHP.
• In collaboration with the Chief Clinical Officer, WSHP Executive Director, and OCA department leadership, develops and executes clinical strategic goals and objectives for WSHP. Develops initiatives to support the triple aim: improving the health of the population, the quality and experience of care our members receive, and lowering the overall cost of care at the population level.
• In collaboration with departmental leadership, is responsible for OCA staff operations for WSHP.
• As requested by the CCO, leads specific elements of OCA strategic planning and addresses key challenges across the organization
• In collaboration with the Executive Director and CCO, builds and maintains strong relationships with stakeholders including the NH Department of Health and Human Services, providers, and member advocacy groups.
• Participates in and chairs clinical committees as requested by the CCO, including but not limited to the NH Provider Advisory Committee, P&T committee and Quality Committee
• Represents the CCO in New Hampshire and other locations as requested.
• Oversees NH utilization management activities, including conducting review of prior authorizations, concurrent reviews and retrospective reviews that do not meet standard criteria and determines coverage.
• Plays an active role in other OCA activities, including provider audit and special investigations, credentialing, and appeals and grievances.
• Supervision of WSHP OCA staff through a matrix reporting structure with department leadership.
• Graduate as a Medical Doctor from an accredited college of medicine is required.
• 8-10+ years of related experience is required including a minimum of 5 years direct clinical experience and a minimum of 3 years experience in medical management and/or strategy.
Certification or Conditions of Employment:
• Board certification in recognized medical specialty
• Unrestricted license as an MD in New Hampshire.
Competencies, Skills, and Attributes:
• Passion for performance and process improvement and its link to population health, quality, and total cost of care.
• Distinctive ability to solve complex problems.
• Excellent demonstrated clinical skills and knowledge.
• Flexible, innovative, and creative; willing to share fresh perspectives and new ideas for the full
• Continuum of care.
• Exceptional ability to communicate and present complex concepts to a wide variety of audiences.
• High-integrity leadership with team orientation. Ability to manage through uncertainty and complexity.
• Results-driven with a keen ability to influence others and build trusting relationships
• Ability to manage staff in a matrix organization, balancing local needs of Well Sense office with the departmental and other needs within OCA.
• Experience in New Hampshire preferred.
• Health plan and/or provider administrative experience preferred.
• Ability to travel to locations within New Hampshire and Massachusetts on a weekly basis.
*Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status.
Internal Number: 2014151
About Well Sense Health Plan
BMC HealthNet Plan is a non-profit managed care organizations committed to providing the highest quality healthcare coverage to underserved populations. In Massachusetts, BMC HealthNet Plan is the business name for Boston Medical Center Health Plan, Inc.; outside Massachusetts, Well Sense Health Plan is the business name.