Part-Time Medical Director - Arbitrations & UM (Hybrid)

Blue Shield of CA; Oakland (CA); Hybrid; USD 90,000 - 140,000; Part time

Benefits offered by this job

Hybrid work model

Job summary

Blue Shield of California is seeking a part-time Medical Director, Arbitrations and UM MD Float to provide clinical review for provider arbitrations across Commercial and Medicare lines. This role will offer flexible UM coverage and report to Sr.

Medical Director, Arbitration/SIU/Mandates/Specialty Director Oversight. The position requires an MD or DO, CA medical license, ABMS board certification, and a minimum of five years of direct patient care.

Qualifications

• Medical degree required.
• Residency completed in an adult primary care specialty or relevant 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 after residency.
• Proficiency in utilization management, Medicare, NCQA/URAC or quality programs, policies and procedures, provider arbitration or litigation support, appeals and grievances, and case management.
• Health plan or medical leadership experience preferred.
• Knowledge of evidence-based medical necessity criteria (MCG/InterQual).
• Ability to work independently to achieve objectives in ambiguous situations.
• Strong communication, collaboration, and leadership capabilities.
• Proficient with MS Office applications (Excel, Outlook, Word, PowerPoint).

Responsibilities

• Provide clinical review and support for provider arbitrations across Commercial and Medicare lines.
• Provide flexible UM Medical Director coverage based on operational needs.

Skills

Communication skills

Leadership

Collaboration

Analytical thinking

Time management

Organizational skills

Independent work

Policy & medical necessity knowledge

Education

MD or DO

Residency in internal medicine or family medicine

Active CA medical license

ABMS board certification

Tools

Microsoft Excel

Outlook

Word

PowerPoint

Job description

Blue Shield of California is seeking a part-time Medical Director, Arbitrations and UM MD Float to provide clinical review for provider arbitrations across Commercial and Medicare lines. This role will offer flexible UM coverage and report to Sr.

Medical Director, Arbitration/SIU/Mandates/Specialty Director Oversight. The position requires an MD or DO, CA medical license, ABMS board certification, and a minimum of five years of direct patient care.