Lead Medical Director, Market Support
Blue Shield of California - San Francisco, CA

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The Lead Medical Director, Market Support (Medical Director) is dedicated to supporting the Blue Shield of California Markets, and specifically the sales, marketing and account services teams, so as to promote growth and increased market share, and supports Health Care Services so as to ensure that HCS products and services anticipate and meet the needs of our customers, both internal and external. The Medical Director reports to the Chief Health Officer and manages a small staff.

Specific Responsibilities Include:

Lead the Healthcare Services (HCQA) Team Supporting Markets Team

To achieve BSC growth in membership and market share, thereby enabling our mission to make high quality health care accessible to all Californians at an affordable price, the Lead Medical Director-Market Support has the following responsibilities:

Ø Provide strategic and operational leadership for the clinical team supporting the Markets Team.

Ø Participate in client and producer facing activities including finalist presentations and account services meetings, broker and consultant meetings, meetings with PBGH, etc.

Ø Participate in the planning, development, and delivery of HCS-related materials to clients, producers and business associations that describe and explain the operational details and value of HCS capabilities, services and programs.

Ø Work collaboratively with other HCS and BSC staff to quickly resolve client service issues, with particular emphasis on clinical issues. Be available to talk with key account members about their issues and the solutions.

Ø Understand utilization bench marks to be able to identify significant variances in key clients’ utilization experience. Provide strategic guidance to key clients to help them lower healthcare cost trends through benefit design, member engagement or through the use of targeted medical and wellness programs.

Ø Be prepared to speak about high cost claimants to determine if Blue Shield has been using the appropriate clinical programs to help manage the condition and the cost and to give guidance regarding the likelihood of the case continuing at a high spend rate.

Ø Be a strategic thought-partner for key clients who want best-in-class medical, health and wellness programs.

Market Advocacy

To enable HCS to be responsive to customer requests and on the cutting edge of providing efficient, effective member engagement and health improvement and management programs to our members and customers, the Lead Medical Director-Market Support has the following responsibilities:

Ø When client requests for new or modified programs present operational and/or budgetary challenges for HCS, Lead Medical Director-Market Support will evaluate the merit of client’s requests and advocate for and support pilots of the meritorious requests and work with sales team and clients to develop alternate solutions for non-meritorious requests.

Ø Quickly communicate client expectations internally at BSC and manage those expectations so as to find win-win solutions for clients that BSC and HCS can deliver.

Ø Provide strategic market knowledge to help HCS build a strategy to meet evolving market needs and competitor capabilities.

Tools and methods by which the Lead Medical Director-Market Support will do the work

Ø The Lead Medical Director-Market Support will use the utilization analysis performed by Health Data Reporting (HDR) to explain key cost drivers to clients. Lead Medical Director-Market Support will be able to walk the client through the entire deck upon occasion and by prior arrangement.

Ø The Lead Medical Director-Market Support will use the information gathered by HDR from EDH systems and Alere to craft the story of the high cost claimants.

Subject Matter Expert

The Lead Medical Director-Market Support serves as a resource and subject matter expert for numerous BSC functions such as:

Ø Current HCS offerings in medical management and wellness

Ø New programs and services of interest to clients, brokers and consultants

Ø eValue8 and other client-related health plan assessment tools

Ø Performance Guarantees

Ø Use of reference pricing, maximum allowable for Out of Network and other benefit design strategies.

Job Required Education/Experience
Candidate Profile and Requirements :


Ø Active, unencumbered CA license (MD or DO)

Ø 5 years managed care experience, including management/people leadership experience

Ø Prior health plan experience preferred - specifically supporting Sales and Account Services

Ø At least five years clinical experience

Other requirement

Ø Reside, and able to travel frequently, in California

Ø Strong familiarity with California managed care marketplace

Ø Prior experience with Blues Plans.

Ø Previous experience in similar sales role.

Required Skills:

Ø People leadership skills

Ø Ability to effectively execute on cross-functional innovative projects in a complex operating environment

Ø Excellent verbal and written communication skills, including ability to speak comfortably and

Ø E xtemporaneously to diverse audiences

Ø Ability to explain program, clinical, operational, and quantitative information in a business-like, clear, coherent, and comprehensible way to lay people

Ø Strong quantitative and analytic skills working with claims, operational, and clinical data and reports

Ø Excellent interpersonal communication skills, including active listening, self-management and awareness, emotional intelligence, and ability to flex interpersonal style situationally

Ø Good skills with negotiation and creative solutioning

Ø Working knowledge/skills with Microsoft Office including Outlook, Word, Excel, and PowerPoint

Key leadership competencies

Ø Business Acumen

Ø Drive for Results

Ø Leadership Influence

Ø Interpersonal Excellence

Ø Integrity/Ethics/Trust

Ø Change Management

Ø Balanced Perseverance

Ø Ownership

Ø Team Collaboration

Ø Relationship Building

Ø Communication

Ø Customer Focus

Ø Financial/Quantitative Acumen

Ø Seasoned Critical Thinking

Other requirement

Ø Reside, and able to travel frequently, in California


Ø Medical degree

Ø Active, unencumbered CA license (MD or DO)

Job Additional Education/Experience
Our Culture

Blue Shield is dedicated to a healthy and happy workforce. Our aim is to hire people who will thrive in our environment and care about what we care about. When everyone is 100% responsible for sustaining our culture it ensures that we maintain a great work place. Because we are a health care company it is essential that employees hold personal wellness a priority no matter where he/she is with their health status. Our internal wellness program, Wellvolution is an award-winning wellness program proven to boost employee health, enhance productivity and reduce medical claims costs. We work hard to make it easy to live well at Blue Shield.

Our culture is a mission-driven culture. We count on every employee to assist making our mission a reality. While we are pursuing our mission and strategy, we expect that all employees are stewards of our company values. These values create our culture:

Creates a trusting environment

Trusted and Trusting

Displays a genuine interest in people’s well being

Valuing People

Holds self and others accountable for achieving outcomes

Results Oriented

Effectively drives & leads change

Agile and Nimble

Actively seeks input from others across the enterprise


Fosters an environment of learning from both success and failure

Creative Solutioning

Demonstrates a commitment to the customer in everything they do

Customer Centric


BSC offers a competitive compensation package comprised of base salary, annual bonus, and full employee benefits (including a defined benefit plan for pension and retiree medical).

Blue Shield of California is committed to remaining a drug-free work place. All positions require a pre-employment background investigation and drug screen. Blue Shield of California is an Equal Opportunity Employer.