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Medical Director, Commercial
Location
United States
Posted
47 days ago
Salary
$202K - $303K / year
Seniority
Lead
No structured requirement data.
Job Description
Medical Director, Commercial
Excellus BlueCross BlueShield
Role Description The Medical Director participates in the broad array of activities of the Medical Services area including, but not limited to: - Medical and Pharmacy Utilization Management - Quality management - Member care management - Medical policy processes - Support for various lines of business The incumbent also provides input into the development of policies, programs, and strategic objectives that cover Medical Management Services through their required participation in various committees and when assigned to other committees or workgroups as requested by leadership. They also act as a liaison with local physicians and hospitals and keep abreast of practice patterns, issues, and concerns of their regional medical community, as well as support our Provider Relations team as requested. This position is occasionally required to work evenings during high volume periods and staff shortages, e.g. cross-coverage vacations. Qualifications - Minimum of seven (7) years of clinical practice experience after completion of all graduate medical education training, including residency and fellowship (when applicable). - Medical Degree: MD or DO from an accredited institution required. - Active board certification in Professional Medical Specialty. - Active unrestricted medical license to practice medicine in a state or territory of the United States. - The Physician is not the subject of any pending professional disciplinary action that could result in the impairment of their ability to practice medicine. - Knowledge of applicable state and federal laws, NCQA standards, and Utilization Management. - Demonstration of effective use of word processing, spreadsheet, email. - Strong interpersonal skills essential for communication to staff at all levels of the organization. - Demonstration of strong and effective abilities in teamwork, negotiation, conflict management, decision-making, and problem-solving skills. - Ability to work within changing business environment and balance patient advocacy with business needs. - Successful ability to assess complex issues, to determine and implement solutions, and resolve problems. - Demonstrated sensitivity to culturally diverse situations, participants, and customers/members. Requirements - Leads, develops, directs, and implements clinical and non-clinical activities that impact health care quality cost and outcomes. - Identifies and develops opportunities for innovation to increase effectiveness and quality. - Serves as a mentor or coach to other Medical Directors and other colleagues in quality and performance improvement processes. - Conduct clinical appeal case reviews and may require peer-to-peer discussions with providers regarding UM case review determinations. - Provides input into the utilization management program policies and procedures. - Assists in many aspects of frontline UM during high peak activity or staff outages. Benefits - Compensation Range: $202,000.00 - $303,000.00 - Participation in group health and/or dental insurance - Retirement plan - Wellness program - Paid time away from work - Paid holidays Physical Requirements - Ability to work prolonged periods sitting at a workstation and working on a computer. - Ability to work while sitting and/or standing while at a workstation viewing a computer and using a keyboard, mouse and/or phone for three (3) or more hours at a time. - Typical office environment including fluorescent lighting. - Ability to work in a home office for continuous periods of time for business continuity. - Ability to travel across the Health Plan service region for meetings and/or trainings as needed. - Ability to lift, carry, push or pull 15 pounds or less. - Manual dexterity including fine finger motion required. - Repetitive motion required. - The ability to hear, understand and speak clearly while using a phone, with or without a headset.
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