Hybrid Medical Director: Utilization, Care & Quality

CareFirst, Inc.; Baltimore (MD); Hybrid; USD 226,000 - 419,000; Full time

Job summary

CareFirst BlueCross BlueShield in the Baltimore metro area seeks a Medical Director to oversee utilization review, care management and quality, directing medical effectiveness of proposed treatments and approving care plans. The role focuses on collaboration with nursing, pharmacy, legal and policy teams and leadership in committees to ensure regulatory compliance.

The position requires an MD with residency training and 11+ years of clinical practice, MD/DC/VA licensure or willingness to obtain

Qualifications

• Medical degree from an accredited medical school with American residency training.
• 11 years of clinical practice experience.
• Maryland/DC/VA physician license without restriction; or Maryland license with willingness to obtain DC/VA licenses; Board Certification.

Responsibilities

• Oversee utilization review, care management and quality to determine medical effectiveness of proposed treatments and approve care management plans.
• Provide clinical support for nursing staff, pharmacy, legal and public policy.
• Participate in key committees (credentialing, quality improvement, technology assessment, medical policy, care management) to meet regulatory and accreditation standards.
• Serve as a resource for network physicians for peer-to-peer case discussions.

Skills

Managed care concepts

Coordinating with physicians

HIPAA knowledge

Evidence-based guidelines

Education

Medical Degree

Tools

Job description

CareFirst BlueCross BlueShield in the Baltimore metro area seeks a Medical Director to oversee utilization review, care management and quality, directing medical effectiveness of proposed treatments and approving care plans. The role focuses on collaboration with nursing, pharmacy, legal and policy teams and leadership in committees to ensure regulatory compliance.

The position requires an MD with residency training and 11+ years of clinical practice, MD/DC/VA licensure or willingness to obtain