Part-Time Medical Director, Arbitration & UM Coverage

Blue Shield of CA; Lodi (CA); Hybrid; USD 120,000 - 180,000; Part time

Job summary

Blue Shield of CA is seeking a Medical Director, Arbitrations and UM MD Float to provide clinical review for provider arbitrations across Commercial and Medicare lines. This part-time, 0.6 FTE role offers flexible UM medical director coverage based on operational needs.

The candidate should be an MD/DO with residency in primary care or related specialty, CA license, and ABMS board certification, plus 5+ years of direct patient care experience and strong communication skills.

Qualifications

• Medical degree required (M.D. or D.O.).
• Residency completed in internal medicine or family medicine, or relevant specialty.
• Active, unrestricted California medical license required.
• Board certification in ABMS-recognized specialty (Internal Medicine preferred).
• Minimum of 5 years of direct patient care after residency.
• Experience with utilization management, Medicare, NCQA/URAC or quality programs.
• Ability to work independently to meet objectives in ambiguity.
• Excellent written and verbal communication skills.
• Strong collaboration and leadership abilities.

Responsibilities

• Provide clinical review and support for provider arbitrations across Commercial and Medicare.
• Offer flexible UM Medical Director coverage based on operational needs.
• Communicate complex analyses in clear, compelling ways to diverse stakeholders.

Skills

Communication skills

Analytical skills

Team collaboration

Independent work

Time management

Presentation skills

Microsoft Excel

PowerPoint

Clinical leadership

Education

M.D. or D.O.

Residency in internal or family medicine

ABMS board certification

Tools

Microsoft Word

Outlook

Job description

Blue Shield of CA is seeking a Medical Director, Arbitrations and UM MD Float to provide clinical review for provider arbitrations across Commercial and Medicare lines. This part-time, 0.6 FTE role offers flexible UM medical director coverage based on operational needs.

The candidate should be an MD/DO with residency in primary care or related specialty, CA license, and ABMS board certification, plus 5+ years of direct patient care experience and strong communication skills.