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

Blue Shield of CA; Springfield Meadows (CA); Hybrid; USD 90,000 - 130,000; Part time

Benefits offered by this job

Hybrid work arrangement

Job summary

Blue Shield of CA is seeking a Medical Director, Arbitrations and UM MD Float to support provider arbitrations across Commercial and Medicare lines. This 0.6 FTE, part-time role offers hybrid virtual work with office visits as needed.

You will review clinical cases, apply evidence-based criteria, and lead in a dynamic medical management team. The role requires an MD with board certification, California licensure, and at least 5 years of patient care experience.

Qualifications

• Medical degree (M.D. or D.O.) required.
• Completed residency in an adult-based primary care specialty or 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.
• Proficiency in utilization management, Medicare, quality programs, medical policies, provider arbitration or litigation support, appeals and grievances, or population health.
• Knowledge of evidence-based medical necessity criteria (e.g., MCG or InterQual).
• Strong communication and collaboration skills; ability to lead and influence teams.
• Proficiency with Microsoft Excel, Outlook, Word, and PowerPoint.

Responsibilities

• Provide clinical review and support for provider arbitrations across Commercial and Medicare lines.
• Deliver flexible UM Medical Director coverage based on operational needs.
• Collaborate with the Medical Management team to advance value-based care initiatives.

Skills

Communication

Leadership

Analytical thinking

Time management

Education

MD

Residency in internal or family medicine

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 support provider arbitrations across Commercial and Medicare lines. This 0.6 FTE, part-time role offers hybrid virtual work with office visits as needed.

You will review clinical cases, apply evidence-based criteria, and lead in a dynamic medical management team. The role requires an MD with board certification, California licensure, and at least 5 years of patient care experience.