Pt Medical Director

Blue Cross of Idaho is looking for a Part-Time Medical Director to provide clinical expertise to the organization to ensure effective utilization management review according to standards of quality and medical necessity for the delivery of integrated healthcare and to support the care management function.
This position reports to the VP Medical Director and is located in Meridian, Idaho. Hybrid work schedule is supported. #LI-Hybrid
To be considered for this opportunity, you have:
Experience: 5 years of clinical practice or related experience
Education:

• Doctorate Degree in Medicine
• Residency or Fellowship in a residency program approved by the Accreditation Council for Graduate Medical Education (ACGME)

Licenses/Certifications:

• Current, unrestricted medical license - either Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO)
• Board Certification via the American Board of Medical Specialties (ABMS) or Specialty Board
• Ability to obtain an Idaho Medical License

We'd also love it if you had:

• Managed care experience, either with a medical group or health plan
• Experience in medical administration

In this role, we will ask you to:

• Interpret existing policies and develop new policies based on changes in the healthcare industry standards or medical evidence.
• Provide guidance and direction to staff in the development of cost, utilization, and medical review activities.
• Provide direction, support, and medical expertise to the organization in matters of case management, underwriting, new product development, claims, quality improvement, provider contracting, and other inquiries that require medical review.
• Participate in and contribute to interdisciplinary case conference discussions in support of member care and clinical staff development.
• Ensure enforcement of member and provider contracts with state, federal, and plan medical policies and/or guidelines.
• Review provider practices that need assistance to correct over-utilization of services, excessive fees, inappropriate services, or sub-optimal care.
• Represent the organization at professional organizations and act as a liaison with health services professionals and trade organizations.
• Performs other duties and responsibilities as assigned.

Reasonable accommodations
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed above 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.
We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.