Lead Medical Director; Hybrid

Lead Medical Director (Hybrid) – Care First Blue Cross Blue Shield

Under the leadership of the Chief Medical Officer, promotes and supports the corporate mission of transforming the health‑care experience with and for our members and communities through developing, defining, and recommending uniform policies related to medical, behavioral health, technology assessment, quality, and credentialing. Represents the company interfacing with healthcare delivery partners and other key external constituents and stakeholders. Provides expert advice, advocacy and counsel to executive and administrative leadership.

We are looking for an experienced clinical leader in the greater Baltimore metropolitan area who is willing and able to work in a hybrid model. The incumbent will be expected to work a portion of the week from home and a portion of the week at a Care First location based on business needs and work activities/deliverables that week.

• Provides advice and counsel to executive and corporate administrators on medical and administrative matters related to medical practice and care delivery. Provides consultation to internal public policy leaders regarding legislative agenda and mandates.
• Represents Care First/Health Services with external constituents and stakeholders such as health‑care delivery partners, insurance commissioners, media, and regional medical societies.
• Ensures that the provision of healthcare service to the membership is compliant with the medical policies and standards. Participates in medical necessity reviews.
• Directs and collaborates with the activities of key corporate committees.
• Contributes to the thought leadership and supports all areas of Health Care Services.
• Assists with directing, coaching, and guiding associates to implement departmental, divisional, and organizational mission/goals.

• Education: Medical degree from an accredited medical school and completion of an American residency program.
• Licenses /
  
  Certifications:
  
  MD – Physician – State Licensure;
  Current medical license in Maryland without restriction.
• Experience: 5 years clinical experience and 5 years administrative experience in a managed care setting; board certification; prior medical director role in a health‑care company or payer organization.
• Preferred Qualifications: Working knowledge of both commercial and government programs lines of business.

• Proficient in utilization management processes, quality assurance standards, and managed care.
• Strong people management and leadership experience in a clinical environment.
• Effective written and oral communication skills.
• Understanding of health‑care claims data, trend analysis, and insurance operations.
• Ability to coordinate and collaborate with physicians and other stakeholders.
• Data‑driven decision making.
• Ability to meet deadlines and handle multiple demands with service excellence.

Salary Range: $253,520 – $470,597

Department: Medical Directors

Equal Employment Opportunity: Care First Blue Cross Blue Shield is an Equal Opportunity (EEO) employer. The company provides equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

Where

To Apply:

Please visit our website to apply:

Federal Disqualification / Physical Demand: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health‑care programs.

Physical Demands: The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. Hands are regularly used to write, type, key and handle small controls. Frequent talking and hearing required. Weights up to 25 pounds occasionally lifted.

Sponsorship in US: Must be eligible to work in the U.S. without sponsorship.