Hybrid Medical Director: Utilization & Quality

CareFirst; Baltimore (MD); Hybride; USD 226 000 - 419 000; Plein temps

Résumé du poste

CareFirst BlueCross BlueShield in Baltimore, MD is seeking a Medical Director to oversee utilization review, care management and quality initiatives across the organization. The role requires a physician with 11 years of clinical practice, board certification, and the ability to work in a hybrid model with some home-based and on-site duties.

The successful candidate will ensure adherence to medical policies, participate in credentialing and quality committees, and provide clinical support across

Qualifications

• Medical Degree from an accredited medical school and completion of residency.
• 11 years of clinical practice experience.
• Current physician license to practice in MD, DC, and VA; or MD license with willingness to obtain DC/VA licenses.
• Board Certification.
• Experience in health plan or payer organizations doing utilization review is preferred.

Responsabilités

• Ensure that the provision of health care service to the membership is compliant with medical policies and standards.
• Oversees utilization review, care management and quality to determine the medical effectiveness of proposed treatments and approve care management plans.
• Provides clinical support for nursing, pharmacy, special investigations, legal, and public policy.
• Participates in credentialing, quality improvement, technology assessment, medical policy, care management and other committees to meet regulatory and accreditation standards.
• Serves as a key resource for network physicians for peer-to-peer case discussion.

Connaissances

Managed care concepts

Care management

Collaboration with physicians

HIPAA knowledge

Evidence-based guidelines

Formation

Medical Degree (MD) from an accredited medical school

Description du poste

CareFirst BlueCross BlueShield in Baltimore, MD is seeking a Medical Director to oversee utilization review, care management and quality initiatives across the organization. The role requires a physician with 11 years of clinical practice, board certification, and the ability to work in a hybrid model with some home-based and on-site duties.

The successful candidate will ensure adherence to medical policies, participate in credentialing and quality committees, and provide clinical support across