Medical Director

Job not on LinkedIn

🕒 May 14

⚜️ Louisiana, North Carolina, +3 more states – Remote

⚜️ Louisiana – Remote 🌲 North Carolina – Remote 🦀 Maryland – Remote 🔔 Pennsylvania – Remote ☕ Washington – Remote

💵 $227.6k - $385k / year

⏰ Full Time

🔴 Lead

👨‍⚕️ Medical Director

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Highmark Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1852

⚕️ Healthcare Insurance

🤝 Non-profit

🌍 Social Impact

💰 $5M Grant on 2021-05

Healthcare Insurance • Non-profit • Social Impact

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 • Complete initial determination of cases, review of appeals and grievances, and other reviews as assigned • Compose clear and concise rationales for member and provider determination notifications • Participate as a member of the CMDM multidisciplinary team • Advise multidisciplinary team on cases that require physician expertise • Actively manage projects and/or participate on project teams that require a physician subject matter expert

🎯 Requirements

• Medical Doctor (MD) or Doctor of Osteopathic Medicine (DO) • 5 years in Clinical, Direct Patient care (hospital, outpatient, or private practice) • 1 year in Medical Management in a Health Insurance Plan preferred • 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 • Strong knowledge of managed care industry preferred