Medicare Medical Director

Nebraska Blue Cross and Blue Shield

Job Overview

Location

Work at Home - Nebraska

Job Type

Full-time

Full Job Description

📋 Description

• The Medicare Medical Director at Nebraska Blue Cross and Blue Shield is a pivotal leadership role responsible for driving clinical excellence, quality improvement, and cost-effective care for the Medicare Advantage population, directly impacting member health outcomes and organizational performance in a rapidly evolving healthcare landscape.
• This position ensures alignment between clinical practice and business strategy by leading initiatives that enhance care delivery, reduce unnecessary utilization, and strengthen provider engagement across Nebraska’s Medicare market.
• What the person will do day to day:
• Oversee clinical, quality, care management, and population health outcomes and cost metrics for the Medicare population, using data to identify trends, gaps, and opportunities for improvement.
• Assess high-impact areas within the Medicare population to pinpoint where clinical interventions, program enhancements, or new care models can yield the greatest improvements in quality and cost efficiency.
• Lead clinical engagement in assigned markets by partnering with the Chief Medical Officer to drive performance improvement in primary and specialty care settings through evidence-based practices and provider collaboration.
• Improve provider clinical documentation and burden of illness capture (Risk Adjustment) to ensure accurate reflection of patient complexity, supporting better care coordination and appropriate resource allocation.
• Develop and nurture relationships with physicians and clinical staff to identify best practices, analyze workflows, and support implementation of quality improvement initiatives that reduce unplanned hospitalizations and emergency department visits.
• Collaborate with internal teams (e.g., care management, pharmacy, analytics) and external partners (e.g., health systems, community organizations) to align quality initiatives and scale successful interventions across the Medicare population.
• Serve as the primary business and clinical liaison to network providers and facilities, ensuring effective communication, trust-building, and execution of Medicare medical services programs.
• Propose and evaluate alternative care delivery models or practice transformation strategies that maintain or improve clinical quality while reducing low-value care and unnecessary costs.
• Develop and sustain strategic relationships with internal stakeholders (e.g., network operations, finance, compliance) and external entities (e.g., CMS, physician groups, advocacy organizations) to support Medicare population health goals.
• About the team or company:
• Nebraska Blue Cross and Blue Shield is a mission-driven, nonprofit health plan committed to improving the health and well-being of its members and the communities it serves, with a strong emphasis on innovation, equity, and patient-centered care.
• As part of Team Blue, you’ll join a collaborative, values-based culture that prioritizes professional growth, work-life balance, and meaningful impact, supported by leadership that invests in employee development and community engagement.
• What the person can learn or achieve in this role:
• Gain deep expertise in Medicare Advantage program management, value-based care transformation, and population health strategy within a leading regional health plan.
• Develop advanced leadership and influence skills by shaping clinical policy, driving provider behavior change, and measuring the real-world impact of interventions on health outcomes and cost savings.

🎯 Requirements

• Doctor of Medicine (M.D. or D.O.) degree from an accredited institution.
• Board certification by an American Board of Medical Specialties (ABMS) member board and a current, unrestricted license to practice medicine in Nebraska or another U.S. state or territory.
• Minimum of seven (7) years of direct clinical patient care experience, with preference for experience in quality improvement, cost containment, or population health initiatives.
• At least two (2) years of managed care experience, ideally with a Medicare Advantage population.
• Ability to travel to on-site provider practices as needed for clinical engagement and relationship building.

🏖️ Benefits

• Hybrid work arrangement: 2–3 days per week in the Omaha, Nebraska office with remote flexibility for the remainder of the week.
• Comprehensive health, dental, and vision insurance plans offered by BCBSNE, including wellness programs and preventive care incentives.
• Retirement savings plan with company matching contributions to support long-term financial security.
• Paid time off (PTO) including vacation, holidays, and sick leave, designed to support work-life balance and employee well-being.
• Professional development opportunities, including access to continuing medical education (CME) and leadership training programs.
• Employee Assistance Program (EAP) offering confidential counseling, legal, and financial support services.

Skills & Technologies

Onsite

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Nebraska Blue Cross and Blue Shield

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About Nebraska Blue Cross and Blue Shield

Nebraska Blue Cross and Blue Shield is a member-owned nonprofit health insurer headquartered in Omaha, providing medical, dental, vision, pharmacy, and supplemental coverage to individuals, families, and employers statewide. Founded in 1939, the company administers self-funded plans, Medicare Advantage, and Medicaid products, operating a statewide provider network of hospitals, physicians, and specialists. It also offers health-management programs, wellness incentives, and digital tools to improve care quality and affordability for more than 750,000 members.

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