Senior Medical Director

Blue Cross and Blue Shield of Nebraska

Senior Medical Director providing clinical leadership in Utilization Management programs at Blue Cross and Blue Shield of Nebraska, focusing on quality and cost efficiency.

Posted 6/3/2026full-timeOmaha • Florida, Iowa, Kansas, Minnesota, Montana, New York, North Dakota, Texas • 🇺🇸 United StatesSeniorWebsite

About the role

Key responsibilities & impact

Provide clinical leadership for utilization management programs
Set UM strategy aligned with organizational goals
Serve as senior clinical advisor to executive leadership on utilization trends
Oversee the medical policy team
Lead the Medical Policy and Utilization Management Governance Committees
Oversee complex and high-risk utilization review cases
Conduct clinical reviews and peer-to-peer reviews
Ensure consistent, evidence-based application of clinical guidelines
Provide clinical expertise to teams conducting coding and payment integrity
Act as senior clinical UM liaison to network providers
Build and maintain strong physician relationships
Lead development and implementation of UM interventions
Review utilization data for improvement opportunities
Ensure UM programs meet regulatory requirements
Conduct and support training of medical directors and UM staff

Requirements

What you’ll need

Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO)
Board Certified by an American Board of Medical Specialties (ABMS) board.
Preferred current, unrestricted medical license in Nebraska
10+ years of combined clinical practice and health care industry experience.
Demonstrated experience in utilization management, medical necessity review, and physician peer review
Demonstrated effective communication skills
Prior experience in a senior or enterprise-level UM leadership role.
Three + years Managed care experience across Commercial and/or Medicare Advantage populations.
Strong background in quality improvement, population health, and cost containment initiatives.

Benefits

Comp & perks

Flexible work arrangements
Professional development

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

utilization managementmedical necessity reviewpeer reviewclinical reviewsevidence-based clinical guidelinescoding integritypayment integrityquality improvementpopulation healthcost containment

Soft Skills

clinical leadershipeffective communicationrelationship buildingstrategic planningteam leadershiptraining and developmentanalytical skillsproblem-solvingcollaborationadvisory skills

Certifications

Doctor of Medicine (MD)Doctor of Osteopathic Medicine (DO)Board Certified by ABMSunrestricted medical license