Senior Medical Director- Multiple Openings

2 weeks ago

Rochester, United States Excellus BlueCross BlueShield Inc Full time

** Senior Medical Director- Multiple Openings (Clinical Services, Commercial, Medicare/Retail Markets)- 000581**

**Job Category****:** Medical Director **Requisition Number****:** SENIO006843 Showing 1 location **Job Details**

**Description**

New Senior Medical Director opportunities available as we add exciting leadership openings within our Medical Director space:

Senior Medical Director openings for Clinical Services (multiple openings:)

* Support for Value Based Programs

* Support Clinical Editing and Coding Initiatives

Senior Medical Director opening for our Commercial Line of Business supporting Univera

* Support for our Buffalo market and organizational relationships

Senior Medical Director opening for our Medicare/Retail Markets Line of Business

* Support for our Medicare/Retail Markets Line of Business while overseeing Quality Improvement Teams and health care measures

This position serves as deputy leader to the VP Medical Affairs and ensures achievement of strategic goals and objectives for the assigned line of business (LOB) and/or functional areas. They actively support the strategy, planning, program development and implementation of their departments portfolio.

Essential Responsibilities/Accountabilities:

* In a matrixed approach, oversees and directs the work of team members and actively supports goals across all LOBs.

* Routinely updates leadership team on specific issues of importance brought forward by the Health Plans Medical Directors.

* Provides medical leadership, clinical consultation, and subject matter expertise specific within their scope

* Serves as a clinical link to other aspects of the Medical Services Division and PHE.

* Contributes to various corporate committees, initiatives, projects, or programs, as assigned.

* Performs case reviews and appeals on claims and pre-authorization requests, as assigned.

* Supports Provider Relations, as needed.

* Works to maximize effectiveness and efficiency across all LOBs and PHE.

* Participates in the annual departmental goal setting process.

* Works to facilitate the achievement of the Medical Management Program goals through an effective health services delivery system.

* Actively participates in the auditing of medical management processes and corrective action team projects for medical management.

* Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies mission and values, adhering to the Corporate Code of Conduct, and leading to the Lifetime Way values and beliefs.

* Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.

* Maintains knowledge of all relevant legislative and regulatory mandates and ensures that all activities are in compliance with these requirements.

* Conducts periodic staff meetings to include timely distribution and education related to departmental and Ethics/Compliance information.

* Performs other duties and functions as assigned by management.

Minimum Qualifications:

* Medical Degree, either M.D. or D.O.

* Board Certification

* Active NYS Medical License

* Three years of supervisory and/or management experience

* Three years of experience as a Medical Director for a health plan or equivalent experience

* Strong verbal, written and interpersonal communication skills

* Demonstrable understanding of managed care and delivery structures of healthcare

* Valid NYS Drivers License

Physical Requirements:

* Must be able to travel independently between the health plan regions

************

The Lifetime Healthcare Companies aims to attract the best talent from diverse socioeconomic, cultural and experiential backgrounds, to diversify our workforce and best reflect the communities we serve.

Our mission is to foster an environment where diversity and inclusion are explicitly recognized as fundamental parts of our organizational culture. We believe that diversity of thought and background drives innovation which enables us to provide leading-edge healthcare insurance and services. With that mission in mind, we recruit the best candidates from all communities, to diversify and strengthen our workforce.

OUR COMPANY CULTURE:

Employees are united by our Lifetime Way Values & Behaviors that include compassion, pride, excellence, innovation and having fun We aim to be an employer of choice by valuing workforce diversity, innovative thinking, employee development, and by offering competitive compensation and benefits.

In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position.

Equal Opportunity Employer

**Qualifications**

**Skills**

**Behaviors**

**:**

**Motivations**

**:**

**Education**

**Preferred**

Doctorate or better in Review Required.

Physician or better in Physician.

**Experience**

**Licenses & Certifications**

**Required**

Medical Doctor

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractors legal duty to furnish information. 41 CFR 60-1.35(c)

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