Excellus BCBS

Medical Director, Commercial

Rochester, New York, United States of America · Director

Sponsorship not specified$202k-$303kDetected 35 days ago

NegotiationRecruitingHRISResearchLeadershipCommunicationProblem SolvingPublic Speaking

About the role

Essential Accountabilities: Level I Reviews and makes recommendations and/or decisions on Utilization or Case Management activities.
Utilization review activities include: reviews of requests for broad range of medical services including medications, medical and surgical services at first level, appeal and inquiries.
Conducts peer-to-peer clinical reviews with attending physicians or other providers to discuss review determinations with providers and external physicians.

MD or DO from an accredited institution required.
The Physician is not the subject of any pending professional disciplinary action that could result in the impairment of their ability to practice medicine.
Knowledge of applicable state and federal laws, NCQA standards, and Utilization Management.
Demonstration of effective use of word processing, spreadsheet, email.
Must be able to research clinical issues.
Strong interpersonal skills essential for communication to staff at all levels of the organization.
Demonstration of strong and effective abilities in teamwork, negotiation, conflict management, decision-making, and problem-solving skills.
Ability to work within changing business environment and balance patient advocacy with business needs.

$202,000.00 - $303,000.00 The salary range indicated in this posting represents the minimum and maximum of the salary range for this position.
Actual salary will vary depending on factors including, but not limited to, budget available, prior experience, knowledge, skill and education as they relate to the position's minimum qualifications, in addition to internal equity.
The posted salary range reflects just one component of our total rewards package.
Please note: There may be opportunity for remote work within all jobs posted by the Excellus Talent Acquisition team.
This decision is made on a case-by-case basis.
One I.D.E.A. One you.

reviews of requests for broad range of medical services including medications, medical and surgical services at first level, appeal and inquiries.
Makes accurate and consistent interpretation of integral medical policy, contract benefits and State and Federal Mandates and maintains current and working knowledge of Utilization Management Standards.
Reviews and makes recommendations on medical policies, guidelines and medical criteria.
Assists with training medical director colleagues and nursing staff, including leadership of teaching grand round activities, and case consistency conferences.

Employer Compensation Range(s): $202,000.00 - $303,000.00 The salary range indicated in this posting represents the minimum and maximum of the salary range for this position.
Actual salary will vary depending on factors including, but not limited to, budget available, prior experience, knowledge, skill and education as they relate to the position's minimum qualifications, in addition to internal equity.
The posted salary range reflects just one component of our total rewards package.
Other components of the total rewards package may include participation in group health and/or dental insurance, retirement plan, wellness program, paid time away from work, and paid holidays.

This listing is sourced directly from Excellus BCBS's careers page and normalized into a canonical job model.