BlueCross BlueShield of Tennessee
Lead Medical Director
This job is now closed
Job Description
- Req#: R-40086
Employer Industry: Healthcare Insurance
Why Consider this Job Opportunity:
- Competitive salary up to 5 years of clinical experience
- Opportunity for career advancement and growth within the organization
- Proficient in Microsoft Office (Outlook, Word, Excel, and PowerPoint)
- Ability to work independently or in a team environment
- Outstanding negotiation, presentation, and facilitation skills
- Knowledge of Medicare programs
What to Expect (Job Responsibilities):
- Develop and administer inter-reviewer reliability methodology for medical necessity determinations
- Analyze and apply clinical metrics to support medical management and quality improvement initiatives
- Direct and support physician review for UM and Appeals reviews
- Lead and serve on various committees to achieve medical utilization, cost, and quality objectives
- Willingness to travel within the State of Tennessee and nationally
What is Required (Qualifications):
- Current MD or DO degree with an unencumbered and unrestricted license to practice medicine in Tennessee
- Board Certification in a recognized specialty by the American Board of Medical Specialties or the American Board of Osteopathic Specialists
- 5 years of clinical experience
- Healthcare administration and/or UM experience preferred
- Ability to interpret and explain complex government policies
How to Stand Out (Preferred Qualifications):
- 0-2 years of experience as an Rx Technician or Customer Service Representative in a healthcare-related service
#HealthcareInsurance #CareerOpportunity #CompetitivePay #MedicarePrograms #HealthcareAdministration
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We are not the EOR (Employer of Record) for this position. Our role in this specific opportunity is to connect outstanding candidates with a top-tier employer.About the company
BlueCross BlueShield of Tennessee is the largest health benefit plan company in Tennessee.
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