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Medical Director

Blue Cross Blue Shield of Nebraska
Omaha, Nebraska, United States (on-site)
15 days ago

Description

Blue Cross and Blue Shield of Nebraska (BCBSNE) is more than just an insurance company; we exist to be there for people in the best and hardest moments of their lives.

Our team is the power behind that promise. And, as the industry rapidly evolves and we seek ways to optimize business processes and customer experiences, there’s no greater time for forward-thinking professionals like you to join us in delivering on it!

As a member of Team Blue, you’ll find purpose, opportunities and the support you need to build a meaningful career and make a powerful impact in our community.

BCBSNE is happy to offer three work designations for our Omaha based employees: 100% in-office, Hybrid, or 100% remote. 

This position is a physician leader who provides leadership in utilization, prior authorization and case management, and utilization management and drug utilization management appeals for BlueCross BlueShield of Nebraska. The individual is responsible for enhancing relationships with providers and facilities, make utilization and prior authorization determinations, assist in case management and be a project manager for medical management programs.

What you'll do:

1. Oversee utilization review/quality assurance, directing case management while located in a state or territory of the United States and holding an active, unrestricted license in the same licensure category as the ordering Provider; or as Doctor of Medicine, or Doctor of Osteopathic Medicine

2. Support the Medical Management staff ensuring timely and consistent responses to members and providers.

3. Act as lead business and clinical liaison to network providers and facilities to support the effective execution of medical services programs by the clinical teams.

4. Provide clinical expertise and business direction in support of medical management programs through participation in clinical team activities

5. Responsible for predetermination reviews ad reviews of claim determinations, providing clinical, coding, and reimbursement expertise.

6. Craft and implement interventions that improve outcomes

7. Provide alternative approaches that can improve practice performance while achieving similar or greater clinical quality

8. Conduct peer to peer conversations with the attending physician or ordering providers.



Requirements

To be considered for this position, you must have:

  1. Doctorate in Medicine (M.D or D.O) and seven (7) years of experience in Health Care Delivery System e.g., Clinical Practice and Health Care Industry. 
  2. Board certified in an American Board of Medical Specialties Board, including post graduate direct patient care experience required.
  3. Nebraska current, unrestricted clinical license.
  4. Three (3) years of direct clinical care in private and/or academic practice

Job Information

  • Job ID: 67881115
  • Workplace Type: On-Site
  • Location:
    Omaha, Nebraska, United States
  • Company Name For Job: Blue Cross Blue Shield of Nebraska
  • Position Title: Medical Director
  • Job Function: Family Medicine Physician
  • Job Type: Full-Time
  • Job Duration: Indefinite
  • Min Education: Ph.D.
  • Min Experience: 5-7 Years
  • Required Travel: 0-10%

Please refer to the company's website or job descriptions to learn more about them.

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