Senior Medical Director – Medical Cost Optimization Strategy

Horizon Connect @ Wall BCBSNJ

. Define and implement a multi-year Medical Cost Optimization strategy to drive affordability .

Posted 10/12/2026full-timeUnited StatesSenior💰 $240,200 - $334,110 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in Medical Cost Optimization strategies, clinical operations, and managed care practices, with a strong focus on data analysis, team leadership, and effective communication across diverse audiences.

Highest-signal resume keywords

MD Or DO LicenseMedical Cost OptimizationManaged Care ExperienceClinical Operations KnowledgeBoard Certification

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Clinical Practice ExperienceUtilization ManagementQuality ManagementPayment IntegrityCase ManagementMedical PolicyData AnalysisROI AnalysisPerformance TrackingRegulatory Compliance

Soft Skills

Influencing Senior ManagementTeam LeadershipEffective CommunicationCritical ThinkingIndependent Judgment

Tools & Technologies

Windows EnvironmentMS Office Products

Certifications & Qualifications

American Board Of Medical Specialties CertificationBoard Certification By A Specialty

Industry Keywords

Managed Care OrganizationMedical ManagementClinical AnalyticsMedical EconomicsCPLT ProcessDRIVE ProcessHorizon BCBSNJNetwork ProvidersTrade OrganizationsState And Federal Regulations

About the role

Key responsibilities & impact

Define and implement a multi-year Medical Cost Optimization strategy to drive affordability
Partner with business-unit leadership to identify MCO opportunities and improve operational processes
Collaborate with Clinical Analytics, Medical Economics, Finance, and other teams to validate business cases
Oversee tracking, analysis, and reporting of MCO data for business cases, ROI analyses, and progress measurement
Direct opportunity and solution evaluation and prioritization using the MCO Committee governing framework
Facilitate and participate in MCO Committee meetings
Facilitate prioritization of MCO solutions needing funding through CPLT and DRIVE processes
Partner with MCAP, Finance, and Actuary teams on enterprise MCO and MCAP performance tracking and reporting
Communicate MCO strategy, activity, and results across HNS and the enterprise
Communicate MCO efforts externally to network providers and trade organizations
Educate Horizon BCBSNJ staff on MCO tools, strategies, and programs
Manage, develop, and train staff; develop and monitor goals; conduct annual performance reviews; administer staff salaries

Requirements

What you’ll need

MD or DO with a current unrestricted license to practice medicine
American Board of Medical Specialties (ABMS) board certification
Minimum 5 years of clinical practice experience
Minimum 3 years of experience in managed care/medical management
Proficiency working with a Windows based environment including MS Office products
3 years of management experience
Knowledge of clinical operations within a managed care organization
Experience with utilization management, quality, payment integrity, case management, and/or medical policy
Knowledge of medical cost optimization
Broad clinical skills to understand medical issues
Active, unrestricted MD or DO license required; NJ license preferred
No CMS sanctions or sanctions by other regulatory agencies or boards
Board certification by a specialty recognized by the American Osteopathic Association or the American Board of Medical Specialties
Ability to influence and challenge senior management and staff
Ability to manage and lead through influence in a highly matrixed environment
Ability to develop staff and leverage team capabilities
Ability to present and interact with senior leadership
Ability to tailor communication and messages to diverse audiences
Ability to develop staff competencies related to medical cost optimization and executive decision-making skills
Ability to exercise independent judgment in making decisions
Ability to interpret and apply state and federal regulations, hospital and provider contracts, and medical policy
Effective verbal and written communication and presentation skills
Ability to work well within a team
Proven ability to innovate, be goal oriented, possess strong critical thinking skills, and exercise sound judgment
Travel within NJ/NY/PA required as needed
Employees must live in New Jersey, New York, Pennsylvania, Connecticut, or Delaware

Benefits

Comp & perks

Comprehensive health benefits (Medical/Dental/Vision)
Retirement Plans
Generous PTO
Incentive Plans
Wellness Programs
Paid Volunteer Time Off
Tuition Reimbursement