Hybrid Medical Director, Health Plan & Care Quality

CareFirst BlueCross BlueShield; Baltimore (MD); Hybrid; USD 226,000 - 419,000; Full time

Benefits offered by this job

Benefits package

Incentive programs

401k contribution

Job summary

CareFirst BlueCross BlueShield is seeking a Medical Director to oversee utilization review, care management and quality to determine the medical effectiveness of proposed treatments. The role supports a hybrid schedule with a mix of home and CareFirst location work in the greater DC/Baltimore area, and requires multi-state licensure.

The ideal candidate will have 11 years of clinical practice, a MD from an accredited school, US residency training, and board certification.

Qualifications

• Medical Degree from an accredited medical school.
• Completion of an American residency program with postgraduate training.
• 11 years of clinical practice experience.

Responsibilities

• Oversees utilization review, care management and quality to determine medical effectiveness of proposed treatments.
• Approves care management plans and ensures cost-effective care delivery.
• Provides clinical support for nursing, pharmacy, investigations, legal, and public policy teams.
• Participates in credentialing, quality improvement, technology assessment, medical policy and care management committees to meet regulatory and accreditation standards.
• Serves as a key resource for network physicians for peer-to-peer case discussion.

Skills

Managed care concepts

Physician collaboration

HIPAA knowledge

Evidence-based guidelines

Care quality oversight

Education

Medical Degree

US residency training

Board Certification

Job description

CareFirst BlueCross BlueShield is seeking a Medical Director to oversee utilization review, care management and quality to determine the medical effectiveness of proposed treatments. The role supports a hybrid schedule with a mix of home and CareFirst location work in the greater DC/Baltimore area, and requires multi-state licensure.

The ideal candidate will have 11 years of clinical practice, a MD from an accredited school, US residency training, and board certification.