Managed Healthcare Executive - June Issue

Planning a career transition into managed care? Managed markets? Health insurance companies?

You can read the June issue of Managed Healthcare Executive to read about health care reform, health policy, transparency, utilization review, health management, pharmacy best practices, managed care outlook, and more.

Managed Healthcare Executive August Issue

Interested in learning more about the health insurance industry? If you're thinking about working in managed care, then you won't want to miss reading Managed Healthcare Executive.

You can read the August Issue of Managed Healthcare Executive here.

Managed Healthcare Executive: June 2012

Interested in a career in the managed care industry? One way to understand the current trends and issues that are relevant to the health care industry is to read trade journals and magazines. You can read the June 2012 issue of "Managed Healthcare Executive" here.

Job Posting: Product Leader – Acquisition and Retention, McKinsey Healthcare Revenue Solutions

Job Posting: Product Leader – Acquisition and Retention

McKinsey Healthcare Revenue Solutions:

McKinsey & Company is developing advanced analytic solutions across a number of domains to augment our traditional consulting model. In healthcare we are building a new standalone Informatics business to provide US health insurance companies with advanced analytics solutions that help them optimize their revenue and profit given the changes brought on by reform. This business operates as an internal startup led by a dedicated McKinsey partner and a former senior health insurance executive. We are assembling a dedicated team of advanced analytic experts, operational managers and client leaders with experience across health insurance, risk management and consumer marketing. We are looking for select leaders who see the opportunity that US health reform presents and are excited to help us build a new business. Our hub locations are New York, Chicago and Gurgaon (for Analytics).

Job Posting: Client Service Executive, McKinsey Healthcare Revenue Solutions

Job Posting: Client Service Executive

McKinsey Healthcare Revenue Solutions:

McKinsey & Company is developing advanced analytic solutions across a number of domains to augment our traditional consulting model. In healthcare we are building a new standalone Informatics business to provide US health insurance companies with advanced analytics solutions that help them optimize their revenue and profit given the changes brought on by reform. This business operates as an internal startup led by a dedicated McKinsey partner and a former senior health insurance executive. We are assembling a dedicated team of advanced analytic experts, operational managers and client leaders with experience across health insurance, risk management and consumer marketing. We are looking for select leaders who see the opportunity that US health reform presents and are excited to help us build a new business. Our hub locations are New York, Chicago and Gurgaon (for Analytics).

Job Post: Associate National Medical Director

Job Post: Associate National Medical Director
Amerigroup Corporation - Norfolk, Virginia Area

Job Description

Provide clinical leadership and expertise to the development and implementation of national programs designed to assure members receive appropriate and timely access to health care services in a cost effective manner. Under the direction of the National Medical Director, provide clinical support to the Reimbursement Policy Management Department, Clinical Operations Department, Pharmacy Department and other Amerigroup departments as assigned. Work collaboratively with HCMS and other Amerigroup departments to achieve overall organizational goals and objectives.

Deep Medicare pay cuts could drive physicians to seek sources for supplemental income

Deep Medicare pay cuts may drive physicians to seek out ways to generate supplemental income. Some physicians may drop Medicare by changing their Medicare participation (PAR) status to non-participation (non-PAR). Of course, this will mean that thousands of Medicare patients may need to find a new health care provider.

Another option is for physicians to find ways to supplement their income through a variety of non-clinical jobs and opportunities. Some may wish to explore the world of medical writing while others may carve out some time to do some consulting. Many physicians are already involved in medicolegal review or reviewing medical charts to assess hospital admissions around "medical necessity." Adventurous physicians who have access to capital are starting their own companies (often on the side while they continue to practice medicine).

Featured Physician Executive: Samuel Nussbaum, MD

This week, our featured physician executive is Samuel Nussbaum, MD
Executive Vice President, Clinical Health Policy, Chief Medical Officer for WellPoint, Inc

Dr. Samuel Nussbaum is Executive Vice President, Clinical Health Policy, Chief Medical Officer for WellPoint, Inc., and Interim President of WellPoint’s Comprehensive Health Solutions Business Unit.

Within Clinical Health Policy, Nussbaum oversees corporate medical policy, clinical pharmacy programs, and public health policy. He also has responsibility for HealthCore, WellPoint’s clinical outcomes research subsidiary. As the leader of Comprehensive Health Solutions, which includes WellPoint’s provider relations, care and disease management, imaging management, personal health guidance companies, and WellPoint’s pharmacy solutions group, Nussbaum is responsible for focusing on the issues of medical cost, quality of care and enhancing member value through innovative health solutions.

Job Post: Assistant Medical Director, Managed Care Team

Signature Healthcare - Massachusetts

Board certified/Board qualified in IM/Geriatric medicine physician. Must possess a current MA medical license, MA CSR and Federal DEA. 5 or more years of clinical experience working in a managed care environment required. Must be comfortable with supervising/leading/working with two managed care NPs.

More information about this position can be found here.

Job Post: Managed Care Medical Director (includes salary info)

Medical Director
Aetna - Phoenix, AZ

POSITION SUMMARY
The Medical Director (MD) is responsible for providing clinical expertise and business direction in support of medical management programs to promote the delivery of high quality, constituent responsive medical care. The MD is a critical medical and business leader and contact for external providers, plan sponsors, and regulatory agencies and participates in the strategic medical management of local markets.

Register for the 2011 Fall Managed Care Forum

2011 Fall Managed Care Forum
November 10-11, 2011
Las Vegas, Nevada

The 2011 Fall Managed Care Forum is being held November 10-11, 2011 at the Bellagio Hotel in Las Vegas, NV. The Fall Forum brings together members and other healthcare executives from the American Association of Integrated Healthcare Delivery Systems (AAIHDS), the American Association of Managed Care Nurses (AAMCN) and the National Association of Managed Care Physicians (NAMCP).

About NAMCP
NAMCP was founded in 1991 to serve the educational interests and needs of physicians working in any form of managed healthcare. NAMCP is run by physicians for physicians. Since physicians affect 85% of the expense side in healthcare, NAMCP believes they should take a proactive role in developing the best delivery system for patients in managed healthcare, thereby increasing quality, reducing costs and improving practice performance and clinical outcomes. Members of NAMCP are medical directors and practicing physicians from purchasers (employers), health plans and provider systems. NAMCP is accredited by the Accreditation Council for Continuing Medical Education to provide continuing education to physicians.

Managed Healthcare Executive

Here's the June 2011 digital issue of Managed Healthcare Executive magazine. Managed Healthcare Executive provides senior-level decision makers the trends, analysis, strategies, and applications they need to innovate value in a rapidly changing health care landscape.

Standard & Poor's Health Care 2011 Conference: Trends and Rating Considerations

Standard & Poor's Health Care 2011 Conference: Trends and Rating Considerations

Date: Tuesday, June 7, 2011

Location:

Standard & Poor's
55 Water Street
Conference Center
37th Floor
New York, NY

Registration is complimentary

Time: 8:00 a.m.-1:30 p.m.

Presentations include:

• Economic Perspective on U.S. Health Care
• Health Insurance Sector Review
• Not-for-Profit Health Care Sector Review
• Corporate Health Care Sector Review

Upcoming teleconference on physician careers in the managed care industry

Updated on May 17, 2011:

Dr. Steven Peskin and I are preparing to host a two-part teleconference on physician careers in the managed care industry. If you're interested in working as a medical director for a health plan, make sure you don't miss these presentations so that you can learn how to find a job in the health insurance industry.

We're planning on holding this two-part teleconference this fall.  (Previously, we had outlined some dates in June but we had some changes in our schedules)

Each teleconference will be recorded and will be made available for purchase. More details coming soon, so please stay tuned...

Consulting jobs in the health IT industry at #HIMSS11

There are a number of health IT consulting jobs advertised here at HIMSS11. Here are a few examples of who's hiring at HIMSS11:

Accenture

• Health & Public Service - Connected Health Ambulatory EMR Implementation Consultant
• MC Pharmacy Benefit Management Consultant
• MC Payer Operations and Excellence Consultant

Ernst & Young

• Advisory Manager - Performance Improvement - Healthcare - Managed Care - Provider
• Positions in: NYC, San Francisco, and Chicago

Physician Careers: Commercial Payors - Dr. John Fallon (MD/MBA 8th AMMP Conference)

Here's a video of a presentation given by Dr. John Fallon at the 8th Annual AMMP conference titled, "Government Payer Careers." I blogged about his presentation (here) back in April when I was in Boston attending the Association of MD/MBA Programs (AMMP) 8th Annual Conference.

Now, you can view a video of his presentation and slides here (you'll need Microsoft Silverlight to play the video).

John Fallon, MD, MBA
Senior Vice President
Chief Physician Executive
Blue Cross Blue Shield of Massachusetts

John is responsible for ensuring the highest standards of medical care for our members. He is also accountable for helping expand health care strategies involving quality, effectiveness, efficiency and their relationships to new payment methodologies. He oversees the company’s medical policies, acts as the main liaison with the plan’s provider network, reviews upcoming legislation for medical impact, manages the company’s medical directors, acts as primary spokesperson for medical inquires and main medical contact with the Blue Cross Blue Shield Association and its 39 plans.

Managed Healthcare Executive (November 2010)

The November 2010 of Managed Healthcare Executive can be viewed here (this is a digital version and you can view archived versions as well). Interested in learning more about the managed care industry? Read about disease management, pay-for-performance, and other health insurance industry issues.

Managed Healthcare Executive provides senior-level decision makers the trends, analysis, strategies, and applications they need to innovate value in a rapidly changing health care landscape.

Physician Careers: Government Payors - Dr. Richard Kalish (MD/MBA 8th AMMP Conference)

Here's a video of a presentation given by Dr. Richard Kalish at the 8th Annual AMMP conference titled, "Government Payer Careers." I blogged about his presentation (here) back in April when I was in Boston attending the Association of MD/MBA Programs (AMMP) 8th Annual Conference.

Now, you can view a video of his presentation and slides here (you'll need Microsoft Silverlight to play the video).

Richard Kalish, MD, MPH
Medical Director
Boston HealthNet
Boston Medical Center HealthNet Plan

Richard Kalish, MD, MPH, MS, is an assistant professor of medicine and family medicine at Boston University School of Medicine and Director for Community Engagement at Boston University Clinical and Translational Science Institute (BU CTSI). He is Medical Director of Boston HealthNet, a network of fifteen community health centers, Boston Medical Center and the Boston University School of Medicine. He is the chairman of the Boston HealthNet Research Sub-Committee. In addition, he is Medical Director of the Boston Medical Center HealthNet Plan, a provider-sponsored Managed Care Plan with insurance products in both Medicaid and Commonwealth Care (a government sponsored product which came about with Massachusetts Health Care reform in 2006). In both of these medical director roles Dr. Kalish works with community health centers, hospitals serving the underserved and other safety net providers. The work involves population and disease management models aimed at improving the health of people and communities. The models focus on both chronic diseases and prevention. In addition, he has led practice redesign efforts in the network. Results have included processes to improve access in ambulatory practices, utilization of an electronic medical record for decision support and improved communication between health care providers. Currently he is involved in working on establishing medical home care environments in a few of the community health centers.

Health reform driving layoffs in the insurance industry

It's no surprise that insurance companies are restructuring in anticipation of major health reform changes. There's one article published in American Medical News titled, "Another insurer blames health reform for layoffs."

Assurant Health says the cuts will help "streamline its organizational structure" to prepare for changes in the insurance marketplace.

This is probably not the best time to leave clinical medicine to pursue non-clinical career opportunities in the health insurance industry. Then again, maybe the government will need to hire hundreds of physicians to serve as medical directors for the Public Option. Would you like to work for the government so that you can deny medical claims? How will the government define "medical necessity" as they roll out the Public Option to the 46 million uninsured individuals who are living in the United States?

American Academy of Insurance Medicine (AAIM)

The American Academy of Insurance Medicine (AAIM) is among the oldest medical specialty organizations in the United States. Our physician members typically serve as medical directors to insurance companies. Members may serve these companies as advisors for underwriting and consultants for claims and disability management. Other roles include medical and actuarial research, underwriting guideline development, employee health education and care, and as professional liaison to the medical community, legislative bodies and regulatory agencies.

Membership is open to physicians who are Medical Directors of insurance companies, nurses, underwriters, medical consultants and other professionals working in insurance medicine, as well as to affiliates who have a professional interest in insurance medicine.

http://www.aaimedicine.org