Part-Time Medical Director, Arbitration & UM — Hybrid

Blue Shield of CA; San Diego (CA); Hybrid; USD 150,000 - 210,000; Part time

Job summary

Blue Shield of CA is seeking a Medical Director, Arbitrations and UM MD Float to provide clinical review and support for provider arbitrations across Commercial and Medicare lines, with flexible coverage according to operating needs.

The role emphasizes independent work, leadership, and strong communication to guide complex analyses and influence decision-making, while maintaining a California medical license and ABMS board certification.

Qualifications

• Medical degree (MD/DO) required.
• Residency completed in an adult-based primary care specialty or other related field.
• Active, unrestricted California medical license required.
• Board certification in an ABMS-recognized specialty required (Internal Medicine preferred).
• Minimum of 5 years of direct patient care experience after residency.
• Experience with utilization management or related medical leadership is preferred.

Responsibilities

• Provide clinical review and support for provider arbitrations across Commercial and Medicare lines of business.
• Provide flexible UM Medical Director coverage based on operational needs.
• Lead and communicate analyses clearly to diverse stakeholders.
• Collaborate with cross-functional teams to apply evidence-based medical necessity criteria.

Skills

Communication skills

Leadership

Analytical thinking

Time management

Collaboration

Education

Medical degree (MD/DO)

Residency in internal or family medicine

Active California medical license

ABMS board certification (Internal Medicine preferred)

Tools

Microsoft Excel

Outlook

Word

PowerPoint

Job description

Blue Shield of CA is seeking a Medical Director, Arbitrations and UM MD Float to provide clinical review and support for provider arbitrations across Commercial and Medicare lines, with flexible coverage according to operating needs.

The role emphasizes independent work, leadership, and strong communication to guide complex analyses and influence decision-making, while maintaining a California medical license and ABMS board certification.