Blue Cross and Blue Shield of Kansas City
Medical Director
Blue Cross and Blue Shield of Kansas City, Kansas City, Missouri, United States, 64101
Guided by our core values and commitment to your success, we provide health, financial, and lifestyle benefits to ensure a best-in-class employee experience. Some of our offerings include:
Highly competitive total rewards package, including comprehensive medical, dental, and vision benefits, as well as a 401(k) plan with contributions from both employee and employer.
Annual incentive bonus plan based on company achievement of goals.
Time off including paid holidays, paid time off, and volunteer time off.
Professional development courses, mentorship opportunities, and tuition reimbursement.
Paid parental and adoption leave with financial assistance.
Employee discount program.
Job Description Summary:
Provides medical leadership and physician advice for the Medical Management function, and offers leadership to other divisions of BCBSKC and the community.
Job Responsibilities:
Provides management oversight and development for a major program within Medical Management, such as medical policy, credentialing, utilization management, case management, and others. Acts as senior clinical staff for credentialing or utilization management, guiding clinical operations and quality improvement. Chairs relevant committees.
Improves quality and efficiency of care, guides providers in clinical initiatives, and manages utilization for medical, surgical, and pharmacy activities.
Participates in medical appeals, reviews overturned cases, and updates policies accordingly.
Serves as an expert/resource on appeals related to utilization management.
Provides medical leadership and advice to quality management, performs peer reviews, and participates in quality improvement activities.
Acts as a physician advisor for various departments including Sales, Marketing, Legal, and Provider Services.
Provides leadership ensuring conformance with standards from NCQA, URAC, and regulatory bodies.
Communicates with physicians, hospitals, and providers in the community.
Reviews customer service and claims inquiries.
Minimum Qualifications:
M.D. or D.O. degree from an accredited medical school.
At least 5 years of clinical practice experience post-residency or fellowship.
Board certification in an ABMS specialty, with ongoing certification.
Experience in quality and utilization improvement projects.
Excellent communication skills.
Knowledge of managed care, including Medicare Advantage, Medicaid, or Commercial products.
Unrestricted medical license in Missouri and Kansas or willingness to obtain.
Experience with case management, social determinants of health, and team collaboration.
Preferred Qualifications:
Advanced degrees such as MBA, MHA, or MPH.
Experience in utilization management within a medical management organization.
Knowledge of national guidelines like MCG or Inter Qual.
Specializations such as Internal Medicine, Family Practice, Geriatrics, Emergency Medicine.
Skills in analytics and participation in quality and utilization management teams.
Blue Cross and Blue Shield of Kansas City is an equal opportunity employer. All qualified applicants will receive consideration without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, veteran status, or disability.
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Highly competitive total rewards package, including comprehensive medical, dental, and vision benefits, as well as a 401(k) plan with contributions from both employee and employer.
Annual incentive bonus plan based on company achievement of goals.
Time off including paid holidays, paid time off, and volunteer time off.
Professional development courses, mentorship opportunities, and tuition reimbursement.
Paid parental and adoption leave with financial assistance.
Employee discount program.
Job Description Summary:
Provides medical leadership and physician advice for the Medical Management function, and offers leadership to other divisions of BCBSKC and the community.
Job Responsibilities:
Provides management oversight and development for a major program within Medical Management, such as medical policy, credentialing, utilization management, case management, and others. Acts as senior clinical staff for credentialing or utilization management, guiding clinical operations and quality improvement. Chairs relevant committees.
Improves quality and efficiency of care, guides providers in clinical initiatives, and manages utilization for medical, surgical, and pharmacy activities.
Participates in medical appeals, reviews overturned cases, and updates policies accordingly.
Serves as an expert/resource on appeals related to utilization management.
Provides medical leadership and advice to quality management, performs peer reviews, and participates in quality improvement activities.
Acts as a physician advisor for various departments including Sales, Marketing, Legal, and Provider Services.
Provides leadership ensuring conformance with standards from NCQA, URAC, and regulatory bodies.
Communicates with physicians, hospitals, and providers in the community.
Reviews customer service and claims inquiries.
Minimum Qualifications:
M.D. or D.O. degree from an accredited medical school.
At least 5 years of clinical practice experience post-residency or fellowship.
Board certification in an ABMS specialty, with ongoing certification.
Experience in quality and utilization improvement projects.
Excellent communication skills.
Knowledge of managed care, including Medicare Advantage, Medicaid, or Commercial products.
Unrestricted medical license in Missouri and Kansas or willingness to obtain.
Experience with case management, social determinants of health, and team collaboration.
Preferred Qualifications:
Advanced degrees such as MBA, MHA, or MPH.
Experience in utilization management within a medical management organization.
Knowledge of national guidelines like MCG or Inter Qual.
Specializations such as Internal Medicine, Family Practice, Geriatrics, Emergency Medicine.
Skills in analytics and participation in quality and utilization management teams.
Blue Cross and Blue Shield of Kansas City is an equal opportunity employer. All qualified applicants will receive consideration without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, veteran status, or disability.
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