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Associate Medical Director

Company: Blue Cross and Blue Shield of North Carolina
Location: Durham
Posted on: June 14, 2019

Job Description:

JOB DESCRIPTION

Medical Directors bring a unique set of knowledge and skills to the business of Blue Cross and Blue Shield of North Carolina (BCBSNC). The application of their knowledge and clinical skills is across all lines of business and different divisions. The incumbent frequently is an interface between BCBSNC and physicians, providers and members and is expected to contribute in the following areas with the priorities and focus referenced in a description of specific duties, which may be outlined separately.

Key Job Functions - General

* Utilizes clinical knowledge and experience to ensure that BCBSNC coverage decisions are clinically appropriate and member-centric.

KEY JOB FUNCTIONS DEPARTMENT SPECIFIC

* Corporate Pharmacy

* Provides clinical support to the Pharmacy Department and may be required to perform reviews of clinical information and make coverage determinations as part of the Pharmacy Management Programs and other product lines, e.g., Medicare Part D.

* Healthcare Management & Operations

* Works with the clinical and non-clinical staff. Their activities will focus on the utilization of medical policy and clinical judgment to determine benefit coverage for services based on the member s contract and clinical needs. Provide support to other medical management initiatives and programs such as but not limited to disease management, case management, and medical expense management. The Lead Medical Director, in co-operation with senior management, will determine other duties.

HIRING REQUIREMENTS

* MD or DO degree from an accredited medical school

* Completion of residency training program in ABMS/AOA recognized clinical specialty

* 3 years clinical experience after the completion of residency training program is required

* A current North Carolina Medical License, without restriction.

HIRING PREFERENCES

* 3 years administrative medicine/managed care (utilization and disease management) experience.

* Knowledge and understanding of appropriate NC and federal legislation

* Strong people skills and the ability to be resourceful , as well as to make concise, independent and defensible decisions in often high-pressure situations.

* Proven ability to effectively communicate orally and in writing detailed and complex information to others that possess varying degrees of comprehension.

* Board certification in primary specialty (ABMS or AOA approved specialty/subspecialty).

* Ability to fulfill provider credentialing requirements for BCBS NC within 90 days of hire..

Blue Cross and Blue Shield of North Carolina does not discriminate on the basis of race, color, national origin, sex, age or disability in its health programs and activities.

Keywords: Blue Cross and Blue Shield of North Carolina, Durham , Associate Medical Director, Executive , Durham, North Carolina

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