Regional Medical Director – Utilization & Policy

Horizon Blue Cross Blue Shield; Newark, Northern (NJ, KY); Hybrid; USD 214,000 - 298,000; Full time

Job summary

Horizon Blue Cross Blue Shield seeks a Medical Director to provide regional clinical leadership for the New Jersey provider network. You will oversee utilization management, care management, disease and quality initiatives, education for providers, and support for provider relations while coordinating with hospitals and physicians to advance value-based care.

This senior role requires board certification, an active NJ license, and a proven track record in clinical data analysis, policy

Qualifications

• Board-certified physician with an active NJ license.
• 5–7 years of clinical experience in managed care or hospital settings.
• Experience analyzing data to inform decisions for executive management.
• Proficiency with Tableau or similar analytics tools.
• Strong collaboration with cross-functional teams and providers.

Responsibilities

• Lead utilization, care, disease, and quality management initiatives.
• Provide medical policy input and support reimbursement policy development.
• Collaborate with providers, hospitals and internal teams across NJ.
• Analyze data on case management and utilization to address variances.
• Contribute to education, committee work, and network transformation.

Skills

Board Certified

NJ License

Clinical Experience

Utilization Management

Data Analysis

Leadership

Education

MD or DO

Tools

Tableau

MS Office

Job description

Horizon Blue Cross Blue Shield seeks a Medical Director to provide regional clinical leadership for the New Jersey provider network. You will oversee utilization management, care management, disease and quality initiatives, education for providers, and support for provider relations while coordinating with hospitals and physicians to advance value-based care.

This senior role requires board certification, an active NJ license, and a proven track record in clinical data analysis, policy