See more Collapse

Medical Director

2 months ago

Omaha, United States BlueCross BlueShield of Nebraska Full time

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 four work designations for our Omaha area employees: 100% in-office, Hybrid - 3 days in office, Hybrid - 2 days in office, 100% remote. Occasional visits to the office.

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 four work designations for our Omaha area employees: 100% in-office, Hybrid - 3 days in office, Hybrid - 2 days in office, 100% remote. Occasional visits to the office.

This position is a physician leader who provides leadership in utilization, prior authorization and case management 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. This position will act as a back-up to the Chief Medical Officer.

What you'll do: Assist the Chief Medical Officer with medical policy related business decisions.

Acts as an administrative and clinical leader to other Medical Directors

Oversee utilization review/quality assurance, directing case management

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

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

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

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

Craft and implement interventions that improve outcomes

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

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

To be considered for this position, you must have: PHD in Medicine (M.D or D.O) and ten (10) years of experience in Health Care Delivery System e.g., Clinical Practice and Health Care Industry.

Board Certified in an American Board of Medical Specialties Board, and an active, unrestricted license to practice medicine in a state or territory of the United States, including post graduate direct patient care experience required.

Nebraska active, unrestricted clinical license.

Three (3) years of direct clinical care in private and/or academic practice.

Three (3) years prior experience with Medicare Advantage.

Three (3) years prior managed care experience.

Previous experience with administrative oversight of the medical function of an insurance (or related) company.

An equivalent combination of education and experience may be substituted for this requirement. The ability to meet or exceed the attendance and timeliness requirements of their departments. The ability to work well in a team environment and be capable of building and maintaining positive relationships with other staff, departments, and customers. To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed are representative of the knowledge, skill, and or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Other duties may be assigned. The strongest candidates for this position will also possess: A Master's Degree in Business Administration (MBA)

Learn more about what makes BCBSNE such an exceptional place to work by visiting NebraskaBlue.com/Careers. We strongly believe that diversity of experience, perspective and background will lead to a better workplace for our employees and a better product for our customers and members. Blue Cross and Blue Shield of Nebraska is an Equal Opportunity /Affirmative Action Employer -

Minorities/Females/Disabled/Veterans

Helping diverse candidates find great careers is our goal. The information you provide here is secure and confidential. We are now directing you to the original job posting. Please apply directly for this job at the employer’s website.

#J-18808-Ljbffr

We have other current jobs related to this field that you can find below

  • Psychiatric Medical Director

    3 months ago

    Omaha, United States Heartland Family Service Full time

    Job DescriptionJob DescriptionAt Heartland Family Service, we are committed to building a culture that is trauma informed and values and celebrates diversity and inclusion. We believe this allows for better service delivery and innovation, as it encourages our employees to bring various experiences and uniqueness to the workplace.Trauma Informed Care is an...

  • Psychiatric Medical Director

    2 months ago

    Omaha, United States Heartland Family Service Full time

    Job DescriptionJob DescriptionAt Heartland Family Service, we are committed to building a culture that is trauma informed and values and celebrates diversity and inclusion. We believe this allows for better service delivery and innovation, as it encourages our employees to bring various experiences and uniqueness to the workplace.Trauma Informed Care is an...

  • Physician Center Medical Director

    2 months ago

    Omaha, United States Concentra Career Choice Full time

    Overview: SIGN ON BONUS!!! Are you ready to take your career to new heights? At Concentra, you will be a vital member of our patient care team and play a crucial role in providing exceptional care to our patients. Our mission is to improve the health of America's workforce, one patient at a time. Join us at Concentra and see how your clinical competency and...

  • Physician Center Medical Director

    2 weeks ago

    Omaha, United States Concentra Career Choice Full time

    Job DescriptionJob DescriptionOverviewSIGN ON BONUS!!!Are you ready to take your career to new heights? At Concentra, you will be a vital member of our patient care team and play a crucial role in providing exceptional care to our patients. Our mission is to improve the health of America's workforce, one patient at a time. Join us at Concentra and see...

  • Medical Director Psychiatrist Child-Adolescent

    1 month ago

    Omaha, United States Commonspirit Health Full time

    OverviewCHI Health & Children’s Nebraska are searching for a Medical Director to join the team. As the Medical Director for Children’s Nebraska Acute Behavioral Health Services, you will workin partnership with senior leadership as we prepare for the grand opening of our BehavioralHealth and Wellness Center in 2026. This collaboration between CHI...

  • Medical Director Psychiatrist Child-Adolescent

    1 month ago

    Omaha, Nebraska, United States Commonspirit Health Full time

    OverviewCHI Health & Children's Nebraska are searching for a Medical Director to join the team. As the Medical Director for Children's Nebraska Acute Behavioral Health Services, you will workin partnership with senior leadership as we prepare for the grand opening of our BehavioralHealth and Wellness Center in 2026. This collaboration between CHI Health,...

  • Section Leader of Interventional Cardiology and Medical Director of Cardiac Cath Lab/DOQ

    3 months ago

    Omaha, United States University of Nebraska Medical Center Full time

    Position Summary Interventional Cardiology Section Leader / Cath Lab Medical Director The Division of Cardiovascular Medicine at the University of Nebraska Medical Center in Omaha, NE is seeking an interventional cardiologist to serve as Section Leader of Interventional Cardiology and Medical Director of the Cardiac Cath Lab of our hospital partner,...

  • Medical Director Psychiatrist Child-Adolescent

    2 months ago

    Omaha, Nebraska, United States Catholic Health Initiatives Full time

    OverviewCHI Health & Children's Nebraska are searching for a Medical Director to join the team.As the Medical Director for Children's Nebraska Acute Behavioral Health Services, you will workin partnership with senior leadership as we prepare for the grand opening of our BehavioralHealth and Wellness Center in 2026 . This collaboration between CHI Health,...

  • Medical Director

    1 month ago

    Omaha, NE, United States FCS, Inc. Full time

    Adult Psychiatrist needed for a Medical Director position in Omaha Consideration process will move quickly if you are the right fit! We are also looking for candidates that hold values of integrity, respect, compassion, growth, and excellence. Candidates with experience in corrections a plus. Great pay with AMAZING benefits. If you are qualified and feel...

  • Psychiatric Medical Director

    1 month ago

    Omaha, NE, United States FCS, Inc. Full time

    Located in the suburbs of Omaha, this health system is seeking to hire a Medical Director to oversee their new service line. Wonderful benefits and competitive pay! If you are interested in learning more about this opportunity, contact FCS today at x 244 and email regarding job# NE307a

  • Director, Interprofessional Academy of Educators

    1 month ago

    Omaha, United States University of Nebraska Medical Center Full time

    Position Summary The University of Nebraska Medical Center seeks a transformative leader in teaching and learning to lead the Interprofessional Academy of Educators (IAE). The Academy’s mission is to cultivate a community ​across professions that connects educators with like interests to drive collaboration, innovation and scholarship. The IAE...

  • Director of Microbiology/Faculty Rank DOQ

    1 month ago

    Omaha, Nebraska, United States University of Nebraska Medical Center UNMC Full time

    Director of Microbiology/Faculty Rank DOQ GENERAL REQUISITION INFORMATION EEO Statement: UNMC is an Affirmative Action Equal Employment Opportunity Employer, including an equal opportunity employer of protected veterans and individuals with disabilities. Location Omaha, NE Requisition Number: Department Pathology, Microbiology & Immunology Business...

  • Director of Microbiology/Faculty Rank DOQ

    1 month ago

    Omaha, United States University of Nebraska Medical Center UNMC Full time

    Director of Microbiology/Faculty Rank DOQ GENERAL REQUISITION INFORMATION EEO Statement: UNMC is an Affirmative Action Equal Employment Opportunity Employer, including an equal opportunity employer of protected veterans and individuals with disabilities. Location Omaha, NE Requisition Number: 2024 - 066 Department Pathology, Microbiology & Immunology...

  • Director of Nursing

    3 weeks ago

    Omaha, United States Cedar Creek of Prairie Meadows Full time

    Cedarhurst, a regional healthcare provider and true friend of older adults, seeks a service-minded, career-oriented individual to join our team as a Director of Nursing at our Cedar Creek of Prairie Meadows community.As the Director of Nursing, you will have the opportunity to connect with, and positively impact the lives of, our residents daily! You will be...

  • Director of Nursing

    3 weeks ago

    Omaha, United States Cedar Creek of Prairie Meadows Full time

    Cedarhurst, a regional healthcare provider and true friend of older adults, seeks a service-minded, career-oriented individual to join our team as a Director of Nursing at our Cedar Creek of Prairie Meadows community.As the Director of Nursing, you will have the opportunity to connect with, and positively impact the lives of, our residents daily! You will be...

  • Director of Nursing

    3 weeks ago

    Omaha, United States Cedar Creek of Prairie Meadows Full time

    Cedarhurst, a regional healthcare provider and true friend of older adults, seeks a service-minded, career-oriented individual to join our team as a Director of Nursing at our Cedar Creek of Prairie Meadows community.Interested in this role You can find all the relevant information in the description below.As the Director of Nursing, you will have the...

  • Director of Nursing

    3 weeks ago

    Omaha, United States Cedar Creek of Prairie Meadows Full time

    Cedarhurst, a regional healthcare provider and true friend of older adults, seeks a service-minded, career-oriented individual to join our team as a Director of Nursing at our Cedar Creek of Prairie Meadows community.As the Director of Nursing, you will have the opportunity to connect with, and positively impact the lives of, our residents daily! You will be...

  • General Surgery Program Director

    1 month ago

    Omaha, United States Commonspirit Health Full time

    OverviewProgram Director for General Surgery residency at Creighton University School of Medicine in Omaha, NECreighton University School of Medicine is seeking a Program Director for our ACGME-accredited General Surgery Residency Program based in Omaha, NE. This is a unique opportunity to lead and grow a well-established, robust surgical residency program...

  • General Surgery Program Director

    1 month ago

    Omaha, Nebraska, United States Commonspirit Health Full time

    OverviewProgram Director for General Surgery residency at Creighton University School of Medicine in Omaha, NECreighton University School of Medicine is seeking a Program Director for our ACGME-accredited General Surgery Residency Program based in Omaha, NE. This is a unique opportunity to lead and grow a well-established, robust surgical residency program...

  • Embryology and Andrology Lab Director

    2 weeks ago

    Omaha, United States Bestcare (NY) Full time

    The Region's only medical campus dedicated to women's health. Methodist Women's Hospital delivers more babies than any other hospital in the region. Home to the area's largest maternal-fetal medicine group and a NICU consisting of 65 beds. The hospital offers an array of additional services including surgery, imaging, reproductive health, as well as various...