Medical Director, Medical Policy
Highmark Health
full-time
Posted on:
Location Type: Hybrid
Location: Louisiana, Maryland, North Carolina, Pennsylvania, Washington • 🇺🇸 United States
Visit company websiteSalary
💰 $170,000 - $352,500 per year
Job Level
Lead
About the role
- Supports the Medical Policy team with expertise and knowledge
- Full-cycle ownership of commercial and Medicare Advantage medical policies
- Writing clinical criteria based on research
- Engagement of clinical and non-clinical team members for operational guidelines
- Address escalated inquiries from internal/external partners
- Conducts peer reviews as part of the quality review process
- Participates in various work-groups and sub-committees as a clinical lead/expert
Requirements
- 5 years of Active medical practice
- 3 years of medical policy experience
- 1 year of medical coding experience (preferred)
- Doctor of Medicine or Doctor of Osteopathic Medicine (required)
- Medical Doctor OR Doctor of Osteopathic Medicine (DO), Board certified in an American Board of Medical Specialties or Bureau of Osteopathic, Specialists recognized specialty credentialed in a Highmark network
Benefits
- Health insurance
- 401(k) matching
- Paid time off
- Flexible work arrangements
- Professional development opportunities
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
medical policyclinical criteria writingmedical coding
Soft skills
team engagementpeer reviewoperational guidelines
Certifications
Doctor of MedicineDoctor of Osteopathic MedicineBoard certified