Medical Director

Job not on LinkedIn

🕒 August 10

🏈 Alabama, Alaska, +44 more states – Remote

🏈 Alabama – Remote 🐻 Alaska – Remote 🌵 Arizona – Remote 🏄 California – Remote ⛰️ Colorado – Remote 🦌 Connecticut – Remote 🐊 Florida – Remote 🌺 Hawaii – Remote 🥔 Idaho – Remote 🌽 Illinois – Remote 🌾 Iowa – Remote 🌪️ Kansas – Remote 🐎 Kentucky – Remote ⚜️ Louisiana – Remote 🦞 Maine – Remote 🦬 Montana – Remote 🌾 Nebraska – Remote 🎰 Nevada – Remote 🗻 New Hampshire – Remote 🏖️ New Jersey – Remote 🌶️ New Mexico – Remote 🗽 New York – Remote 🌲 North Carolina – Remote 🌾 North Dakota – Remote 🏈 Ohio – Remote 🌪️ Oklahoma – Remote 🌲 Oregon – Remote 🦀 Maryland – Remote 🍂 Massachusetts – Remote 🚗 Michigan – Remote ❄️ Minnesota – Remote 🎸 Mississippi – Remote 🏰 Missouri – Remote 🔔 Pennsylvania – Remote ⚓ Rhode Island – Remote 🌴 South Carolina – Remote 🗿 South Dakota – Remote 🎸 Tennessee – Remote 🤠 Texas – Remote ⛷️ Utah – Remote 🍁 Vermont – Remote ⚔️ Virginia – Remote ☕ Washington – Remote ⛰️ West Virginia – Remote 🧀 Wisconsin – Remote 🦬 Wyoming – Remote

💵 $227.6k - $385k / year

⏰ Full Time

🔴 Lead

👨‍⚕️ Medical Director

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 34%

What it means: the chance that no one is really hiring for this job.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Highmark Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1852

🛡️ Insurance

💼 Consulting

📦 Logistics

💰 $5M Grant on 2021-05

Insurance • Consulting • Logistics

Highmark Health is a healthcare company committed to reinventing the healthcare system and improving its services for everyone. The organization offers a broad range of career opportunities across various fields such as clinical care, technology, finance, and marketing. Highmark Health emphasizes diversity, equity, and inclusion in its workforce, creating a supportive environment for employees from all backgrounds. The company has been recognized for its commitment to disability inclusion, diversity, and military-friendly employment. As an independent licensee of the Blue Cross Blue Shield Association, Highmark Health strives to create remarkable healthcare experiences for its customers and employees alike.

📋 Description

• Conduct electronic review of escalated cases against medical policy criteria to determine medical necessity and appropriateness • Participate in telephonic peer-to-peer discussions when required • Complete initial determinations, appeals and grievances reviews, and other assigned reviews • Compose clear and concise rationales for member and provider determination notifications • Ensure medical management processes meet community standards of care and compliance requirements • Participate in the CMDM multidisciplinary team, huddles, and grand rounds • Advise multidisciplinary teams on cases requiring physician expertise, particularly high-risk cases • Participate in protocol and guideline development • Manage projects and/or participate on project teams as a physician subject matter expert • Perform other duties as assigned

🎯 Requirements

• Medical Doctor (MD) or Doctor of Osteopathic Medicine (DO) • 5 years in Clinical, Direct Patient care (hospital, outpatient, or private practice) • Awarded Board Certification at least once in specialty recognized by the American Board of Medical Specialties or the American Osteopathic Association Specialty Certifying Boards • Active medical state licensure required; additional specific state licensure(s) may be required based on business need • Compliance with NCQA, URAC, CMS, DOH, and DOL regulations • Preferred: Master's Degree in Business Administration/Management or Public Health • Preferred: 1 year in Medical Management in a Health Insurance Plan; strong knowledge of managed care industry • Critical Thinking • Case Management • Customer Service • Oral & Written Communication Skills • Collaboration • Listening • Telephone Skills • General Computer Skills • Clinical Software • Managed Care • Language (Other than English): None

🏖️ Benefits

• Remote work arrangement • Travel required: 0% - 25%

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