Develops and oversees Cambia’s palliative care business and provider strategy. Provides leadership to strategic partnerships, programs, initiatives and vendors that position Cambia to be a market leader regionally and nationally.
Provides leadership in developing, implementing and communicating short and long-range plans, goals and objectives for palliative care program and team. Aligns team goals with the organization’s vision and strategy for palliative care.
Collaborates with internal colleagues and external constituents to develop and implement campaigns and initiatives related to advancing palliative care knowledge, awareness and utilization.
Oversees the development of effective operational policies, procedures and standards for an effective, integrated palliative care program. Monitors utilization and results and implements process or system changes as needed.
Serves as a subject matter expert on palliative care and engages in public speaking at national conferences, events and other related opportunities. Works with government affairs team to develop and advocate for policies that make palliative care and advance care planning more widely available throughout the country.
Provides medical advice, oversight and leadership for staff to ensure members receive safe, effective and cost efficient services. Provides clinical input on case management reviews working closely with the Case Management clinical staff.
Discusses review determinations with providers who request peer-to-peer conversations. Promotes provider understanding of utilization management and quality improvement policies, procedures and standards.
Leads and/or participates on various teams to provide clinical input on medical policy reviews and development. Collaborates with others to implement actions to reduce medical cost trend (e.g. through medical policies, vendor programs, provider communication and coding).
Stays abreast of industry, medical and technology trends. Identifies and communicates new opportunities in utilization management, provider contracting or other areas that would enhance outcomes and the reputation of the organization.
In-depth knowledge of best practices related to medical care for palliative care conditions. Direct hands-on palliative care experience strongly preferred.
Passion for population health, healthcare transformation, and improving the experience of people with serious illness.
Strong communication and facilitation skills with internal staff and external stakeholders, including the ability to resolve issues and seek optimal outcomes.
Proven ability to develop and maintain positive working relationships with community and provider partners.
Knowledge of the health insurance industry, state and federal regulations, provider reimbursement methods and evolving accountable care and payment models.
Experience with utilization and/or case management reviews.
Detail-oriented with orientation to the application of data and metrics in managing health, quality, and program effectiveness.
Leadership experience with demonstrated ability to effectively build relationships, work with others, and lead people and project teams.
Demonstrated effectiveness in public speaking and delivering impactful messages to a variety of local and national stakeholders
Normally to be proficient in the competencies listed above:
The Palliative Care Clinical Executive would have a MD or DO degree, at least 3 years clinical experience, plus 2 years health plan medical utilization management and/or case management experience or equivalent combination of education and experience. Requires Board Certification with active license to practice medicine in one or more states or territories of the United States and qualification by training and experience to render clinical opinions about medical conditions, procedures and treatments under review.
Note: While MD licensure is preferred, other clinical degrees/licenses will be considered (e.g. BSN, DPh), in which case some changes to responsibilities and pay level for the role may be applied.
Employer will assist with relocation costs.
Internal Number: 24129
About Cambia Health Solutions, Inc.
Regence employees are part of the larger Cambia family of companies, which seeks to drive innovative health solutions. We offer a competitive salary and a generous benefits package. We are an equal opportunity employer dedicated to workforce diversity and a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A drug screen and background check is required.
Regence is 2.2 million members, here for our families, co-workers and neighbors, helping each other be and stay healthy and provide support in time of need. We've been here for members more than 100 years. Regence is a nonprofit health care company offering individual and group medical, dental, vision and life insurance, Medicare and other government programs as well as pharmacy benefit management. We are the largest health insurer in the Northwest/Intermountain Region, serving members as Regence BlueShield of Idaho, Regence BlueCross BlueShield of Oregon, Regence BlueCross BlueShield of Utah and Regenc...e BlueShield (in Washington). Each plan is an independent licensee of the Blue Cross and Blue Shield Association.
If you’re seeking a career that affects change in the health care system, consider joining our team at Cambia Health Solutions. We advocate for transforming the health care system by making health care more affordable and accessible, increasing consumers’ engagement in their health care decisions, and offering a diverse range of products and services that promote the health and well-being of our members. Cambia's portfolio of companies spans health care information technology and software development; retail health care; health insurance plans that carry the Blue Cross and Blue Shield brands; pharmacy benefit management; life, disability, dental, vision and other lines of protection; alternative solutions to health care access and free-standing health and wellness solutions.