Medical Director, Physical Health

2 days ago

w rizz AZ United States Blue Cross Blue Shield of Arizona Full time

Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy. AZ Blue offers a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions.

This position is remote/hybrid within the state of AZ only

PURPOSE OF THE JOB

Direct, lead and provide professional oversight for medical management activities related to the utilization, case, disease, and quality management activities. Support collaborative relationships with physicians and hospitals to achieve mutually acceptable business goals and to ensure that medical policies, procedures, and the activities/actions of the division on behalf of the corporation are consistent with the standards of good medical practice in the community.

QUALIFICATIONS

REQUIRED QUALIFICATIONS

  1. 3 years of experience in a clinical setting
  2. 1 year of experience in a physician leadership role, including quality review, utilization review, and other managed care functions
  3. Medical Degree
  4. Active, current, and unrestricted license to practice medicine in the State of Arizona.
  5. Board Certification

PREFERRED QUALIFICATIONS

  1. 3 years of experience in a primary care field

ESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIES

  1. Provide direction, support medical expertise, and oversight to areas within the Health Services Division including utilization management, quality management, case management, medical claims review, and pharmacy management.
  2. Provide consultative services throughout the corporation, including for the Marketing, Sales, Legal, Actuarial, Network Management, Internal Audit, Finance, and Claims Divisions.
  3. Communicate with customers regarding their difficult and costly cases, including recommendations and showing the impact of BCBSAZ interventions.
  4. Seek to improve department/division efficiency through effective use of information system tools and processes to reduce healthcare costs, increase quality of care and service, and reduce administrative expense.
  5. Review, and implement medical policies and other medical decision-making policies or procedures.
  6. Represent BCBSAZ at professional organizations and acts as liaison with individual health care professionals.
  7. Provide professional oversight for various clinical peer committees.
  8. Participate in the appeals and grievance processes to assure timely and accurate responses to members and providers.
  9. Provide written information to members and providers through letters and articles in member and provider newsletters and other publications.
  10. Provide leadership to staff and other professionals through clinical excellence, professional behavior and innovative thinking.
  11. Monitor quality performance measures, develop and maintain effective workflows, and seek to maximize system efficiencies.
  12. Identify opportunities to achieve administrative efficiencies while maintaining service.
  13. Maintain effective working relationships to ensure teamwork in achieving corporate goals.
  14. Coordinate activities between multiple divisions to achieve desired results.
  15. The position requires a full-time work schedule. Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements.
  16. Perform all other duties as assigned.

COMPETENCIES

REQUIRED COMPETENCIES

  1. Strong written and verbal communication.
  2. Intermediate skill in the use of office equipment, including copiers, fax machines, scanners, and telephones.
  3. Intermediate skills in word processing, spreadsheet, and database software.
  4. Intermediate PC proficiency.
  5. Interpersonal skills that allow for harmonious relationships with providers, members, and coworkers.

Our Commitment

AZ Blue does not discriminate in hiring or employment on the basis of race, ethnicity, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status or any other protected group.

Thank you for your interest in Blue Cross Blue Shield of Arizona. For more information on our company, see azblue.com. If interested in this position, please apply.

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