Child and Family Patient Centered Outcomes Research Scholars Program
Accepting Applicants for August 2016
We are accepting applications for our Child and Family Patient Centered Outcomes Research Scholars Program. This mentored career development (K12) program for junior faculty focuses on patient centered outcomes research and comparative effectiveness research.
This K12 program supports junior faculty, who are on their way to building careers that include research directly linked to delivery systems. The funding for this program comes from the Patient Centered Outcomes Research Institute (PCORI) administered through the Agency for Healthcare Research and Quality (AHRQ). It builds on our fellowship training in the Harvard-wide Pediatric Health Services Research Fellowship, but this program is targeted at junior faculty members, rather than post-doctoral fellows. The three primary sites of the program are Boston Children’s Hospital (BCH), MassGeneral Hospital for Children (MGHfC), and the Department of Population Medicine at Harvard Pilgrim Health Care Institute (DPM). We link with a wide range of delivery systems and have a symposia series on key topics taking place throughout the year. The grant covers 75% of each scholar’s salary (up to a limit of $90,000) for 2-3 years, and provides additional funds (up to $25k annually) for scholars’ research development costs and individual training.
Our leadership team includes Drs. Jonathan Finkelstein (Director, BCH), Erinn Rhodes (Associate Director, BCH), Mark Schuster (BCH), Kenneth Mandl (BCH), Milton Kotelchuck (MGHfC), Karen Kuhlthau (MGHfC), Elsie Taveras (MGHfC), Matthew Gillman (DPM), Grace Lee (DPM), and Don Goldmann (Institute for Healthcare Improvement).
We are accepting applications through November 15, 2015 for positions starting on August 1, 2016. For this program, it is critical that scholars have primary interests in patient-centered outcomes and comparative effectiveness research as defined by PCORI. Applicants must have or concurrently apply for a faculty position at one of our primary sites. Please contact our Associate Director, Dr. Erinn Rhodes (email@example.com) with questions or to request an application form.
Sr Medical Director
Blue Cross & Blue Shield of Rhode Island
Oversee the administration of utilization review, cost & utilization trends and medical policy, provider analysis for BCBSRI. Recommends enhancements to current utilization management, payment policies, quality of care and clinical criteria based on extensive knowledge of health care delivery systems, utilization strategies, reimbursement methods and treatment protocols. Contributes to the analytic efforts of the organization and participates in hospital and physician quality contracting. Additionally, the senior medical director provides clinical insight and direction into the fraud, waste and abuse detection program.
ESSENTIAL JOB FUNCTIONS:
- Monitor the Utilization Review Program. Provide oversight, medical expertise administrative guidance to ensure that all Plan operations and goals for quality, value and cost management are met by the program.
- Establish and maintain up to date and industry-based utilization management performance standards.
- Provides oversight for the analytic activities of the division, including medical informatics, account reporting, predictive modeling and contract operations as it pertains to policy, pricing and provider analysis. Responsible for the analytic design for the corporate transformation strategy.
- Directs the provider profiling activities and serves as the medical director liaison to audit and recovery.
- Develop, implement and monitor clinical guidelines, protocols and programs that accomplish Plan objectives and that meet the medical needs of the member community and the financial needs of the provider community.
- Supervise and direct all physician-related activities, including oversight of work produced by staff Medical Directors.
- Chair and direct the Plan medical committees. Ensure all by-laws are followed, agenda items are completed according to established timeframes, and all issues relative to State, NCQA, CMS and other regulatory issues are achieved thoroughly and on a timely basis. Act as liaison to the Board of Directors and other entities as required and report on the activities of the Plan medical and accreditation committees.
- Other responsibilities as assigned.
Minimum Education and Experience:
- Current, unrestricted license to practice in Rhode Island
- Eight or more years post-graduate experience in private practice with direct patient care
- Three years experience as an Associate or Medical Director in a pre-paid health plan.
- Board Certification in ABMS certified specialty
Preferred Education, Additional Qualifications and Experience:
- Knowledge of CMS Medicare Advantage regulations, NCQA standards, RIDOH regulations
- Knowledge of quality improvement principles and utilization improvement policies and methods to change provider behavior
- Knowledge of finance and reimbursement methodologies
Required Knowledge, Skills, and/or Abilities:
- Managed Care
- Utilization Review
- Quality Improvement
- Analytics and Medical Informatics
- Quality Contracting
- Excellent Verbal and written communication skills
- Handle multiple priorities
- Exercise sound judgment
- Take initiative in finding solutions to difficult and/or sensitive problems
At Blue Cross & Blue Shield of Rhode Island (BCBSRI), diversity and inclusion are central to our core values and strengthen our ability to meet the challenges of today's healthcare industry. BCBSRI is an equal opportunity, affirmative action employer. We provide equal opportunities without regard to race, color, religion, gender, age, national origin, disability, veteran status, sexual orientation, genetic information and gender identity or expression. The law requires an employer to post notices describing the Federal laws prohibiting job discrimination based on race, color, sex, national origin, religion, age, equal pay, disability, veteran status, sexual orientation, and genetic information and gender identity or expression. Please visit http://www1.eeoc.gov/employers/upload/eeoc_self_print_poster.pdf to view the "EEO is the Law" poster.
Employer will assist with relocation costs.
Additional Salary Information: Bonus
Internal Number: Req: #347
About Blue Cross & Blue Shield of Rhode Island
We’re leading the way to improve the healthcare delivery system in our state by:
•Offering innovative benefits that reward members for healthy choices.
•Partnering with primary care physicians to open patient-centered medical homes across the state. We’ve signed patient-centered medical home agreements with more than 25 percent of primary care physicians in the state, which will ultimately im...pact more than 100,000 members.
•Working hard to reinvigorate primary care through increased reimbursements for office visits, a loan forgiveness program, and a grant program for electronic health records.
•Moving toward compensation models that reward physicians for high-quality care instead of the number of services they provide.
•Supporting federal healthcare reform, including covering dependents to age 26 and holding educational sessions on the law.
To improve the quality of life of our customers and of the people of Rhode Island by improving their health.
To improve members’ health and peace of mind by facilitating their access to affordable, high-quality healthcare.
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