Highmark Health

Medical Director, Medical Policy

Highmark Health

full-time

Posted on:

Location Type: Hybrid

Location: Louisiana • Maryland • United States

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Salary

💰 $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 & Tools
medical policyclinical criteria writingmedical coding
Soft Skills
team engagementpeer reviewoperational guidelines
Certifications
Doctor of MedicineDoctor of Osteopathic MedicineBoard certified