Medical Director – Consultant
BlueCross BlueShield of Tennessee
part-time
Posted on:
Location Type: Remote
Location: Remote • Tennessee • 🇺🇸 United States
Visit company websiteJob Level
Lead
About the role
- Develop and administer inter-reviewer reliability methodology to ensure medical necessity determinations are consistent with CMS published guidelines corporate medical review criteria, and medical policy guidelines.
- Analyze, evaluate and apply clinical metrics that produce actionable information in support of medical management and quality improvement initiatives.
- Direct and support physician review to ensure timeliness, accuracy and reliability of UM and Appeals reviews.
- Lead and serve on various committees in order to accomplish medical utilization, cost and quality objectives of BCBST.
- Willingness to travel within the State of Tennessee and nationally.
Requirements
- Current MD or DO degree with an unencumbered and unrestricted license to practice medicine in Tennessee required.
- 5 years - Clinical experience required.
- 5 years - Healthcare administration and/or UM experience preferred.
- Board Certification in a recognized specialty by the American Board of Medical Specialties or the American Board of Osteopathic Specialists.
- Proficient in Microsoft Office (Outlook, Word, Excel and Powerpoint).
- Ability to interpret and explain complex government policies.
- Knowledge of Medicare programs.
Benefits
- Employees who are required to operate either a BCBST-owned vehicle or a personal or rental vehicle for company business on a routine basis will be automatically enrolled into the BCBST Driver Safety Program.
- The employee will also be required to adhere to the guidelines set forth through the program. This includes, maintaining a valid driver’s license, auto insurance compliance with minimum liability requirements; as defined in the 'Use of Non BCBST-Owned Vehicle' Policy (for employees driving personal or rental vehicles only); and maintaining an acceptable motor vehicle record (MVR).
- Health benefits, 401(k) matching, paid time off, flexible work arrangements, and professional development opportunities may be included.
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
clinical metrics analysismedical necessity determinationsutilization managementquality improvement initiativeshealthcare administrationphysician reviewmedical policy guidelinesCMS guidelinesinterpretation of government policiesMedicare programs
Soft skills
leadershipcommunicationorganizational skillsanalytical skillsteam collaborationproblem-solvingattention to detaildecision-makinginterpersonal skillsadaptability
Certifications
MDDOBoard CertificationAmerican Board of Medical SpecialtiesAmerican Board of Osteopathic Specialists