Medical Director

Job not on LinkedIn

🕒 August 10

⚜️ 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

🛡️ 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 rationales for member and provider determination notifications while adhering to NCQA, URAC, CMS, DOH, and DOL compliance standards • Ensure medical management processes align with community standards of care • Participate as a physician member of the CMDM multidisciplinary team • Attend 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 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) required • 5 years in clinical, direct patient care in a hospital, outpatient, or private practice setting required • Board certification awarded at least once in a specialty recognized by the American Board of Medical Specialties or American Osteopathic Association Specialty Certifying Boards required • Active medical state licensure required; additional state licenses may be required based on business need • Strong knowledge of the managed care industry preferred • 1 year in medical management in a health insurance plan preferred • Master's Degree in Business Administration/Management or Public Health preferred • Critical thinking • Case management • Customer service • Oral and written communication skills • Collaboration and listening skills • Telephone skills • General computer skills • Clinical software and managed care knowledge • Travel required 0%–25%

🏖️ Benefits

• Remote/work-at-home arrangement • Base pay range of $227,600.00–$385,000.00 • No required physical work site • Travel required 0%–25%