BCBSAZ
Medical Director - Hybrid
AZ Blue Phoenix, AZ 85021 · Director · Full-time
Sponsorship not specifiedDetected 21 days ago
Code ReviewComplianceAuditingCustomer SupportLeadershipInternal AuditActuarial Science
About the role
- Our positions are classified as hybrid, onsite or remote.
- This position is hybrid within the state of AZ only.
- This hybrid work opportunity requires residency, and work to be performed, within the State of Arizona.
Responsibilities
- Monitor quality performance measures, develop and maintain effective workflows, and seek to maximize system efficiencies.
- Maintain effective working relationships to ensure teamwork in achieving corporate goals.
- Perform all other duties as assigned.
Requirements
- 3 years of experience in a clinical setting
- 1 year of experience in physician leadership role, including quality review, utilization review and other managed care functions
- Required Work Experience
- Required Licenses
- Required Certifications
- Required Education
- Medical Degree
- Active, current, and unrestricted license to practice medicine in the State of Arizona (a state in the United States).
- Board Certification
- Preferred Education
Nice to have
- 3 years of experience in a primary care field
- Preferred Work Experience
- Preferred Licenses
- Preferred Certifications
- Provide consultative services throughout the corporation, including for the Marketing, Sales, Legal, Actuarial, Network Management, Internal Audit, Finance, and Claims Divisions.
- Participate in the appeals and grievance processes to assure timely and accurate responses to members and providers
- Conduct, as appropriate, Appeal Peer Review cases in accordance with the required qualifications.
- Provide written information to members and providers through letters and articles in member and provider newsletters and other publications.
Benefits
- Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy.
- Specific activities include outcome analysis, HEDIS, dispute resolution, regulatory compliance, care and disease management, concurrent review, precertification, medical claims reconsideration and retrospective review.
- 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.
- Review, and implement medical policies and other medical decision-making policies or procedures
- Represent BCBSAZ at professional organizations and acts as liaison with individual health care professionals and supports collaborative relationships with physicians and hospitals.
- Work to ensure productive relationships with all customers, employers, members, and providers to ensure members receive the appropriate health care in the most appropriate setting with the best value in health care.
Company info
- Communicate with customers regarding their difficult and costly cases, including recommendations and showing the impact of BCBSAZ interventions.
- At AZ Blue, we have a hybrid workforce strategy, called Workability, that offers flexibility with how and where employees work.
This listing is sourced directly from BCBSAZ's careers page and normalized into a canonical job model.