Medical Director (Network Performance)

Join Our Team: Do Meaningful Work and Improve People's Lives

Our purpose, to improve customers' lives by making healthcare work better, is far from ordinary. And so are our employees. Working at Premera means you have the opportunity to drive real change by transforming healthcare.

To better serve our customers, we're creating a culture that promotes employee growth, collaborative innovation, and inspired leadership. We are committed to creating an environment where employees can do their best work and where best-in-class talent comes, stays, and thrives! As a result of these efforts we are proud to share that Forbes ranked Premera among America's 2023 Best Midsize Employers (~~~) and America's 2023 Best Employers By State (~~~) .

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Premera is seeking a Medical Dir ector (Network Performance) who will help build and operationalize our strategy to ensure that our networks are delivering value-based care that will, ultimately, improve healthcare outcomes for our members. By working closely with senior leaders, network partners, and other key stakeholders, this role will focus on establishing clear goals, building processes, and implementing solutions designed to ensure that the core philosophies of value-based care are represented and reinforced both internally and within our networks.

This role reports to our Chief Medical Officer and is a key clinical voice within the organization. Working closely with internal and external partners, this role will champion the core elements of value-based care, help teams apply an appropriate lens to the work they perform, and reinforce successful initiatives within our overall network.

Ultimately, this role will be a key player in Premera's continued evolution towards achieving sustainable managed care.

What you will do:

• Collaborate cross-functionally to lead the design, implementation, and adoption of strategic Population Health initiatives focused on improving health outcomes and reducing the cost of care; Work closely with our providers to implement initiatives.

• Utilize data to better understand the market and inform our approaches; Demonstrate progress against goals and ensure measurable and meaningful outcomes.

• Build credibility within the organization and healthcare community to ensure successful partnership and recognition as a thought leader in this space.

• Identify internal opportunities to build/evolve our value-based care mindset; Work closely with internal teams to examine and update policies, procedures, and practices to continue our evolution towards managed care.

• Lead the provider performance improvement teams and ensure that they are focused and successful in supporting priority initiatives that positively impact our network of providers.

• Provide leadership and direction to the team to focus on high-value work and provide developmental support to ensure a healthy organization that has the skills, experience, and motivation to meet the challenges of the future.

• Utilize market knowledge, subject matter expertise, and change management skills to ensure an environment that encourages innovation in a respectful and thoughtful manner.

• Support accreditation and regulatory compliance efforts; Ensure that we have required documentation and processes to meet all requirements.

What you will bring:

• Current, unrestricted medical or administrative license. (required)

• MD or DO degree from an accredited institution. (required)

• 5 years of experience in clinical practice (required)

• Experience in a managed care environment - either with a health plan or medical group - including experience in utilization management.

• Experience with ensuring health plan accreditation.

• Experience with Disease Management, Quality Management, and Pharmacy Management.

• If not currently licensed, can obtain an unrestricted medical or administrative license within 90 days of hire.

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What we offer

• Medical, vision and dental coverage

• Life and disability insurance

• Retirement programs (401K employer match and pension plan)

• Wellness incentives, onsite services, a discount program and more

• Tuition assistance for undergraduate and graduate degrees

• Generous Paid Time Off to reenergize

• Free parking

Equal employment opportunity/affirmative action:

Premera is an equal opportunity/affirmative action employer. Premera seeks to attract and retain the most qualified individuals without regard to race, color, religion, sex, national origin, age, disability, marital status, veteran status, gender or gender identity, sexual orientation, genetic information or any other protected characteristic under applicable law.

If you need an accommodation to apply online for positions at Premera, please contact Premera Human Resources via email at ~~~ or via phone at ~~~.

Premera is hiring in the following states, with some limitations based on role or city: Alaska, Arizona, Arkansas, California, Colorado, Florida, Georgia, Idaho, Iowa, Kansas, Kentucky, Maine, Michigan, Minnesota, Missouri, Montana, Nevada, New Hampshire, New Mexico, North Carolina, Oklahoma, Oregon, South Carolina, South Dakota, Tennessee, Texas, Utah, Washington, Wisconsin .

Salary Range:

$250,000.00 - $400,000.00

At Premera, we make healthcare work better. By focusing on improving our customers' experience purposefully and serving their needs passionately, we make the process easier, less costly, and more positive. Through empathy and advocacy, we change lives.

As the leading health plan in the Pacific Northwest, we provide comprehensive health benefits and services to more than 2 million customers, from individuals to Fortune 100 companies. Our services include innovative programs focused on health management, wellness, prevention, and patient safety. We deliver these programs through health, life, vision, dental, disability, and other related products and services.

Premera Blue Cross is headquartered in Mountlake Terrace, WA, with operations in Spokane and Anchorage. The company has operated in Washington since 1933 and in Alaska since 1952. With more than 80 years of experience in the region, we deliver innovation, choice, and expertise.