Lead Medical Director
Company: BlueCross BlueShield of Tennessee, Inc.
Location: Chattanooga
Posted on: April 19, 2024
Job Description:
Provides clinical leadership and serves as an internal medical
consultant to various divisions and committees to support the
development, implementation and monitoring of medical management
and quality improvement activities.Job Description:Job
Responsibilities
- Develop and administer inter-reviewer reliability methodology
to ensure medical necessity determinations are consistent with CMS
published guidelines corporate medical review criteria, and medical
policy guidelines.
- Analyze, evaluate and apply clinical metrics that produce
actionable information in support of medical management and quality
improvement initiatives.
- Direct and support physician review to ensure timeliness,
accuracy and reliability of UM and Appeals reviews.
- Lead and serve on various committees in order to accomplish
medical utilization, cost and quality objectives of BCBST.
- Willingness to travel within the State of Tennessee and
nationally.Job QualificationsEducation
- Current MD or DO degree with an unencumbered and unrestricted
license to practice medicine in Tennessee required. *However, this
requirement can be waived for jobs where the totality of the
incumbents duties and responsibilities are restricted to the
performance of administrative duties only.
- Based on business need, an unencumbered and unrestricted
license in an alternative state may be substituted.Experience
- 5 years - Clinical experience required
- 5 years - Healthcare administration and/or UM experience
preferred Skills\Certifications
- Board Certification in a recognized specialty by the American
Board of Medical Specialties or the American Board of Osteopathic
Specialists
- Ability to conceive and deliver innovative solutions
- Ability to work independently with minimal supervision or
function in a team environment sharing responsibility, roles and
accountability.
- Outstanding negotiation, presentation, and facilitation
skills
- Proficient in Microsoft Office (Outlook, Word, Excel and
Powerpoint)
- Ability to interpret and explain complex government
policies
- Knowledge of Medicare programsJob Specific Requirements:
-Medicare experience is a plus.Employees who are required to
operate either a BCBST-owned vehicle or a personal or rental
vehicle for company business on a routine basis* will be
automatically enrolled into the BCBST Driver Safety Program. The
employee will also be required to adhere to the guidelines set
forth through the program. This includes, maintaining a valid
driver's license, auto insurance compliance with minimum liability
requirements; as defined in the "Use of Non BCBST-Owned Vehicle"
Policy (for employees driving personal or rental vehicles only);
and maintaining an acceptable motor vehicle record (MVR). *The
definition for "routine basis" is defined as daily, weekly or at
regularly schedule times.Preferred Skills:Number of Openings
Available:1Worker Type:EmployeeCompany:BCBST BlueCross BlueShield
of Tennessee, Inc.Remote-First Statement:BCBST is a remote-first
organization with many employees working primarily from their
homes. Each position within the company is classified as either
fully remote, partially remote, or office based.BCBST hires
employees for remote positions from across the U.S. with the
exception of the following states: California, Massachusetts, New
Hampshire, New Jersey, and New York. Applicants living in these
states may move to an approved state prior to starting a position
with BCBST at their own expense. If the applicant moves to
Chattanooga, TN, they may be eligible for relocation benefits.
Applying for this job indicates your acknowledgement and
understanding of the following statements: BCBST is an Equal
Opportunity employer (EEO), and all employees and applicants will
be entitled to equal employment opportunities when employment
decisions are made. BCBST will take affirmative action to recruit,
hire, train and promote individuals in all job classifications
without regard to race, religion, color, age, sex, national origin,
citizenship, pregnancy, veteran status, sexual orientation,
physical or mental disability, gender identity, or any other
characteristic protected by applicable law.Further information
regarding BCBST's EEO Policies/Notices may be found by reviewing
the following page:BCBST's EEO Policies/Notices BlueCross
BlueShield of Tennessee is not accepting unsolicited assistance
from search firms for this employment opportunity. All resumes
submitted by search firms to any employee at BlueCross BlueShield
of Tennessee via-email, the Internet or any other method without a
valid, written Direct Placement Agreement in place for this
position from BlueCross BlueShield of Tennessee HR/Talent
Acquisition will not be considered. No fee will be paid in the
event the applicant is hired by BlueCross BlueShield of Tennessee
as a result of the referral or through other means. Tobacco-Free
Hiring Statement T o further our mission of peace of mind through
better health, effective 2017, BlueCross BlueShield of Tennessee
and its subsidiaries no longer hire individuals who use tobacco or
nicotine products (including but not limited to cigarettes, cigars,
pipe tobacco, snuff, chewing tobacco, gum, patch, lozenges and
electronic or smokeless cigarettes) in any form in Tennessee and
where state law permits. A tobacco or nicotine free hiring practice
is part of an effort to combat serious diseases, as well as to
promote health and wellness for our employees and our community.
All offers of employment will be contingent upon passing a
background check which includes an illegal drug and
tobacco/nicotine test.An individual whose post offer screening
result is positive for illegal drugs or tobacco/nicotine and/or
whose background check is verified to be unsatisfactory, will be
disqualified from employment, the job offer will be withdrawn, and
they may be disqualified from applying for employment for six (6)
months from the date of the post offer screening results. Resources
to help individuals discontinue the use of tobacco/nicotine
products include smokefree.gov or 1-800-QUIT-NOW. About UsAbout
UsAs Tennessee's largest health benefit plan company, we've been
helping Tennesseans find their own unique paths to good health for
over 65 years. More than that, we're your neighbors and friends -
fellow Tennesseans with deep roots of caring tradition, a focused
approach to physical, financial and community good health for
today, and a bright outlook for an even healthier tomorrow.
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Keywords: BlueCross BlueShield of Tennessee, Inc., Chattanooga , Lead Medical Director, Executive , Chattanooga, Tennessee
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