Medical Director

Found in: Jooble US O C2 - 2 weeks ago

Philadelphia PA, United States Independence Blue Cross Full time
At Independence, everyone can feel valued, supported, and comfortable to be themselves. Our commitment to equity means that all associates have a fair opportunity to achieve their full potential. We put these principles into action every day by acting with integrity and respect. We stand together to speak out against injustice and to break down barriers to support a more inclusive and equitable workplace. Celebrating and embracing the diverse thoughts and perspectives that make up our workforce means our company is more vibrant, innovative, and better able to support the people and communities we serve.

The Medical Director serves as a physician leader responsible for promoting the delivery of safe and effective medical care in the most cost effective way for the health plans offered by Independence Blue Cross and subsidiaries. There are multiple elements of discrete work that may fall under the role including:

Utilization Management

The physician directly supports Utilization Management and Care Management and other business activities where involvement of a physician is determined to be in the best interest of Independence. The Medical Director will be responsible for rendering coverage and payment determinations based on the terms and conditions of the health plans for which Independence serves as claims administrator, and on the terms and conditions of contracts executed between Independence and networks of participating health care providers.

The Medical Director will exercise sound decision making based on clinical guidelines for best practices, a strong knowledge of clinical medicine, the practical realities of the delivery of health care in the state of Pennsylvania, and a thorough understanding of the principles of population health, quality management, patient safety and health insurance. The Medical Director will be expected to effectively collaborate with professional staff, senior leadership, management and associates and with external partners to promote the delivery of cost-effective health care across all lines of business.

Required Qualifications and Experience:
  • We require a Medical Doctor or Doctor of Osteopathy degree from a medical school or osteopathic medical school recognized by the American Association of Medical Colleges (AAMC), the American Osteopathic Association (AOA), or the World Health Organization (WHO).
  • Completion of an accredited residency program in general surgery at a program accredited by the Liaison Committee of Graduate Medical Education (LCGME) or the AOA.
  • Has an unrestricted and unencumbered Pennsylvania or New Jersey licenses to practice clinical medicine or osteopathic medicine.
  • Current Board Certification by ABMS or AOBMS - family medicine board certification preferred
  • Ability to successfully complete Independence Blue Cross credentialing process
Fully Remote:
This role is designated by Independence as fully remote. The incumbent will not be required to report to one of Independence's physical office locations to perform the work. However, the work must be performed in the Tri-State Area of Delaware, New Jersey, or Pennsylvania. #J-18808-Ljbffr

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