Hybrid Part-Time Medical Director - Arbitrations & UM

Blue Shield of CA; Redding (CA); Hybride; USD 120 000 - 180 000; Temps partiel

Résumé du poste

Blue Shield of California is seeking a part-time Medical Director for Arbitrations and UM MD Float to review and support provider arbitrations across Commercial and Medicare lines. The role offers hybrid virtual work with occasional on-site needs, requiring leadership, clear communication, and expertise in evidence-based medical necessity criteria such as InterQual or MCG.

The ideal candidate holds an MD/DO, CA license, 5+ years of clinical experience, and the ability to lead diverse teams and

Qualifications

• MD or DO with medical license in California
• Residency completed in internal medicine, family medicine, or related field
• Board certification in ABMS-recognized specialty (Internal Medicine preferred)
• Minimum 5 years of direct patient care experience after residency
• Experience with utilization management, Medicare, NCQA/URAC or quality programs
• Knowledge of evidence-based medical necessity criteria (MCG/InterQual)
• Ability to work independently and resolve issues in ambiguity
• Strong written and verbal communication and leadership skills
• Proficient with Microsoft Excel, Outlook, Word, and PowerPoint

Responsabilités

• Provide clinical review and support for provider arbitrations across Commercial and Medicare lines
• Deliver flexible UM Medical Director coverage based on operational needs
• Lead and influence teams; translate analyses into actionable guidance

Connaissances

Communication

Collaboration

Analytical skills

Formation

MD/DO degree

Outils

Microsoft Excel

Outlook

Word

PowerPoint

Description du poste

Blue Shield of California is seeking a part-time Medical Director for Arbitrations and UM MD Float to review and support provider arbitrations across Commercial and Medicare lines. The role offers hybrid virtual work with occasional on-site needs, requiring leadership, clear communication, and expertise in evidence-based medical necessity criteria such as InterQual or MCG.

The ideal candidate holds an MD/DO, CA license, 5+ years of clinical experience, and the ability to lead diverse teams and