Medical Director – Medicare Advantage

Job not on LinkedIn

🕒 July 8

⚜️ Louisiana – Remote

⚜️ Louisiana – Remote

⏰ Full Time

🔴 Lead

👨‍⚕️ Medical Director

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👻 Ghost score 29%

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Blue Cross and Blue Shield of Louisiana

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1934

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

Blue Cross and Blue Shield of Louisiana is an independent licensee of the Blue Cross Blue Shield Association, offering a range of health insurance products and services in the state of Louisiana. The company provides health, dental, and travel insurance options, including Medicare Advantage plans such as HMO and PPO. They focus on delivering comprehensive healthcare coverage through various plans to meet varying customer needs, while partnering with doctors, hospitals, and clinics to ensure quality care and support. Additionally, the company emphasizes wellness programs, cost-saving opportunities, and accessibility for its members.

📋 Description

• Promote and support the BlueCross and BlueShield of Louisiana (BCBSLA) Mission Statement. • Reviews treatment procedures and services to ensure that they are within established guidelines or supported by generally accepted medical evidence when formal guidelines do not exist. • To provide direction to operations as applicable, including utilization activities. • Facilitates all physician and provider committees as needed. • Provides advice on external contractual benefit issues. • Interacts with physician and non-physician network providers on programs which may include: Performance Profiling, Disease State Management, Wellness, Medical Policy and claims related issues. • Participates in and supports internal operations such as quality assurance efforts, the BCBSLA Quality Improvement Plan, accreditation/URAC related activities and requirements, medical policy, network operations, diversity initiatives and similar initiatives.

🎯 Requirements

• Doctor of Medicine (M.D.) or Doctor of Osteopathic Medicine (D.O.) required • 7 years of clinical practice experience is required • 3 years of post graduate experience with direct patient care required; prefer 5 years of experience • Administrative experience in a health plan and/or a working knowledge of the insurance industry preferred • Prior detailed experience in either utilization, case or disease management in a hospital or health plan setting preferred • Experience with external accreditation bodies; JCAHO, URAC, or NCQA preferred • Medicare Advantage experience is preferred • Current, license to practice medicine in Louisiana of the type and scope that permits application of clinical judgement in consideration of an individual member’s clinical needs to render a utilization review determination • Must have the ability to obtain a medical licensure for the state of Louisiana required • Board certification in a specialty recognized by ABMS required. • Excellent communication, presentation, interpersonal and human relation skills are required. • Microsoft Office software Word, Excel, Outlook, PowerPoint proficiency required.

🏖️ Benefits

• We take great strides to ensure our employees have the resources to live well, be healthy, continue learning, develop skills, grow professionally and serve our local communities.