Medical Director, Medical Management

Job not on LinkedIn

🕒 November 21, 2025

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

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

💵 $170k - $352.5k / year

⏰ Full Time

🔴 Lead

👨‍⚕️ Medical Director

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 35%

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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. • 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. • Ensure compliance with NCQA, URAC, CMS, DOH, DOL regulations. • Participate in multidisciplinary team for case and disease management. • Manage projects and/or participate on project teams that require physician SME.

🎯 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. • Critical Thinking • Case Management • Customer Service • Oral & Written Communication Skills • Collaboration • General Computer Skills • Clinical Software experience preferred

🏖️ Benefits

• Health insurance • Retirement plans • Paid time off • Flexible work arrangements • Professional development • Additional specific state licensure(s) may be required based on business need. • Opportunities for specialty certification or training as required.