Assistant Medical Director – Oncologist

October 22

☕ Washington – Remote

Although this job is listed in Washington, this company may be open to hiring remote in other states.

💵 $208.8k - $375.8k / year

⏱ Part Time

🔴 Lead

👨‍⚕️ Medical Director

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Premera Blue Cross

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Healthcare Insurance

Premera Blue Cross is an independent health insurance provider, serving businesses and residents of Washington State and Alaska as a licensee of the Blue Cross Blue Shield Association. The company offers a range of health plans including individual, family, employer-based, and Medicare Supplement plans. However, it has announced that it will exit the Medicare Advantage market as of January 1, 2025. Premera is committed to advancing health equity and community support, evident through its Social Impact Program focused on behavioral health and homelessness solutions in Washington and Alaska. Additionally, Premera complies with federal and state civil rights laws, offering language assistance services to ensure equitable care.

1001 - 5000 employees

Founded 1945

⚕️ Healthcare Insurance

📋 Description

• Support clinical review activities, including all of the following: pre-service, post-service, concurrent facility-based care, and transitions between levels of care. • Act as the final decision maker for coverage decisions based on medical necessity, investigational status, other contractual exclusion, or network structure. • Use clinical expertise to support claims review decisions, including level of care, pricing and complexity assessment, dependent disability status and by report procedure payment determinations. • Support the peer-to-peer discussion process by communicating with external physicians and providers about denial determination and collect additional clinical history in each case. • Consult with nursing and other clinical staff to assess and explore care options for members enrolled in clinical programs such as disease management, case management, and care transition management. • Participate in the development, annual review, and approval of company medical review criteria as a member of the Premera Medical Policy Committee. • Leverage clinical knowledge and expertise to support ongoing education for all clinicians involved in medical review. • Provide professional advisement to all requests for consultation from within Premera Blue Cross and with contracted practitioners/ facilities. • Participate in Inter-Rater Review process to ensure consistency in clinical decision-making. • Understand and abide by applicable federal, state, and accreditation regulations and standards. • Complete all professional continuing education requirements and participate in ongoing education/ training as appropriate.

🎯 Requirements

• Physicians license with an MD or DO degree. (Required) • Current board certification in Medical Oncology from the American Board of Internal Medicine is preferred for the Assistant Medical Director with an Oncology focus. (Required) • Unrestricted Washington state licensure or administrative license or an ability to obtain within 90 days. (Required) • Five years of clinical experience. (Required) • Current board certification from the American Board of Medical Specialties, or the American Osteopathic Association, or other recognized Association acceptable to Premera. (Preferred) • Previous experience performing medical necessity and clinical reviews in a health plan setting. (Preferred) • Prior use of clinical criteria sets and clinical pathways, such as MCG ( Milliman Care Guidelines), Interqual®, or others. (Preferred) • Familiarity with CPT, ICD, HCPC code sets, and RBRVS pricing concepts. (Preferred)

🏖️ Benefits

• Medical, vision, and dental coverage with low employee premiums. • Voluntary benefit offerings, including pet insurance for paw parents. • Life and disability insurance. • Retirement programs, including a 401K employer match and, believe it or not, a pension plan that is vested after 3 years of service. • Wellness incentives with a wide range of mental well-being resources for you and your dependents, including counseling services, stress management programs, and mindfulness programs, just to name a few. • Generous paid time off to reenergize. • Looking for continuing education? We have tuition assistance for both undergraduate and graduate degrees. • Employee recognition program to celebrate anniversaries, team accomplishments, and more. • For our hybrid employees, our on-campus model provides flexibility to create your own routine with access to on-site resources, networking opportunities, and team engagement. • Commuter perks make your trip to work less impactful on the environment and your wallet. • Free convenient on-site parking. • Subsidized on-campus cafes make lunchtime connections with colleagues fun and affordable. • Participate in engaging on-site activities such as health and wellness events, coffee connects, disaster preparedness fairs and more. • Our complementary fitness & well-being center offers both in-person and virtual workouts and nutritional counseling. • Need a brain break? Challenge someone to a game of shuffleboard or ping pong while on campus.