Medical Director, Arbitration & UM (Part-Time, Hybrid)

Blue Shield of CA; Long Beach (CA); Hybrid; USD 140,000 - 190,000; Part time

Job summary

Blue Shield of California is seeking a part-time Medical Director for Arbitrations in California. The role provides clinical review and support for provider arbitrations across Commercial and Medicare lines, with flexible UM leadership coverage based on operational needs.

Ideal candidates hold an MD/DO, CA license, ABMS certification (Internal Medicine preferred), and at least 5 years of direct patient care. Strong communication, collaboration, and analytical skills are essential for success.

Qualifications

• Medical degree (M.D. or D.O.) required.
• Completed residency in an adult-based primary care specialty or relevant field.
• Active, unrestricted California medical license required.
• Board certification in an ABMS-recognized specialty (Internal Medicine preferred).
• Minimum of 5 years of direct patient care experience after residency.
• Proficiency in utilization management, Medicare, NCQA/URAC or quality programs, medical policies and procedures, provider arbitration or litigation support, appeals and grievances, and case management or population health.

Responsibilities

• Provide clinical review and support for provider arbitrations across Commercial and Medicare lines.
• Provide flexible UM Medical Director coverage based on operational needs.
• Demonstrate ability to work independently to achieve objectives in ambiguous circumstances.
• Communicate clearly and compellingly to guide and lead others, translating analyses into concise communication.

Skills

Medical degree

Residency completed

Active medical license

Board certification

Direct patient care

Utilization management

Medicare knowledge

Quality programs

MCG/InterQual knowledge

Independent work

Communication

Team collaboration

MS Office

Education

Medical degree (M.D./D.O.)

Residency in internal medicine / family medicine or relevant specialty

Tools

Microsoft Excel

Outlook

Word

PowerPoint

Job description

Blue Shield of California is seeking a part-time Medical Director for Arbitrations in California. The role provides clinical review and support for provider arbitrations across Commercial and Medicare lines, with flexible UM leadership coverage based on operational needs.

Ideal candidates hold an MD/DO, CA license, ABMS certification (Internal Medicine preferred), and at least 5 years of direct patient care. Strong communication, collaboration, and analytical skills are essential for success.