- Clinical experience required+ 5 years \
- Healthcare administration and/or UM experience preferred_Skills\\Certifications_+ Board Certification in a recognized specialty by the American Board of Medical Specialties or the American Board of Osteopathic Specialists+ Ability to conceive and deliver innovative solutions+ Ability to work independently with minimal supervision or function in a team environment sharing responsibility, roles and accountability\.
- Owned Vehicle" Policy \(for employees driving personal or rental vehicles only\); and maintaining an acceptable motor vehicle record \(MVR\)\.
- Free Hiring Statement
- QUIT\ NOW\.
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Medical Director
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Lead Medical Director
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lead medical director
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Lead Medical Director
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Lead Medical Director
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Internal Medicine Medical Director
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Internal Medicine Medical Director
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Lead Medical Director - Chattanooga, United States - BlueCross BlueShield of Tennessee
Description
Provides clinical leadership and serves as an internal medical consultant to various divisions and committees to support the development, implementation and monitoring of medical management and quality improvement activities\Job Description:
*Job Responsibilities
+ Develop and administer inter\-reviewer reliability methodology to ensure medical necessity determinations are consistent with CMS published guidelines corporate medical review criteria, and medical policy guidelines\.+ Analyze, evaluate and apply clinical metrics that produce actionable information in support of medical management and quality improvement initiatives\.+ Direct and support physician review to ensure timeliness, accuracy and reliability of UM and Appeals reviews\.+ Lead and serve on various committees in order to accomplish medical utilization, cost and quality objectives of BCBST\.+ Willingness to travel within the State of Tennessee and nationally\.Job Qualifications
_Education_+ Current MD or DO degree with an unencumbered and unrestricted license to practice medicine in Tennessee required\. \However, this requirement can be waived for jobs where the totality of the incumbents duties and responsibilities are restricted to the performance of administrative duties only\.+ Based on business need, an unencumbered and unrestricted license in an alternative state may be substituted\._Experience_+ 5 years \
Job Specific Requirements:
Medicare experience is a plus\.Employees who are required to operate either a BCBST\-owned vehicle or a personal or rental vehicle for company business on a routine basis\ will be automatically enrolled into the BCBST Driver Safety Program\. The employee will also be required to adhere to the guidelines set forth through the program\. This includes, maintaining a valid driver's license, auto insurance compliance with minimum liability requirements; as defined in the "Use of Non BCBST\
Preferred Skills:
Number of Openings Available:1
Worker Type:Employee
Company:BCBST BlueCross BlueShield of Tennessee, Inc\
Remote\-First Statement:
*BCBST is a remote\-first organization with many employees working primarily from their homes\. Each position within the company is classified as either fully remote, partially remote, or office based\.
BCBST hires employees for remote positions from across the U\.S\.
with the exception of the following states:
California, Massachusetts, New Hampshire, New Jersey, and New York\.
Applicants living in these states may move to an approved state prior to starting a position with BCBST at their own expense\.
If the applicant moves to Chattanooga, TN, they may be eligible for relocation benefits\.*Applying for this job indicates your acknowledgement and understanding of the following statements:
BCBST is an Equal Opportunity employer \(EEO\), and all employees and applicants will be entitled to equal employment opportunities when employment decisions are made\. BCBST will take affirmative action to recruit, hire, train and promote individuals in all job classifications without regard to race, religion, color, age, sex, national origin, citizenship, pregnancy, veteran status, sexual orientation, physical or mental disability, gender identity, or any other characteristic protected by applicable law\.
Further information regarding BCBST's EEO Policies/Notices may be found by reviewing the following page:
BCBST's EEO Policies/Notices \(https:
//www\.bcbst\.com/docs/equal\-employment\-opportunity\.pdf\)BlueCross BlueShield of Tennessee is not accepting unsolicited assistance from search firms for this employment opportunity\. All resumes submitted by search firms to any employee at BlueCross BlueShield of Tennessee via\-email, the Internet or any other method without a valid, written Direct Placement Agreement in place for this position from BlueCross BlueShield of Tennessee HR/Talent Acquisition will not be considered\. No fee will be paid in the event the applicant is hired by BlueCross BlueShield of Tennessee as a result of the referral or through other means\.
Tobacco\
All offers of employment will be contingent upon passing a background check which includes an illegal drug and tobacco/nicotine test\. An individual whose post offer screening result is positive for illegal drugs or tobacco/nicotineand/or whose background check is verified to be unsatisfactory, will be disqualified from employment, the job offer will be withdrawn, and they may be disqualified from applying for employment for six \(6\) months from the date of the post offer screening results\.Resources to help individuals discontinue the use of tobacco/nicotine products include smokefree\.gov or 1\-800\