Medical Director

Job-ID28979419Reference26-21347Remote100% Remote100% Remote in the 28 states - North Carolina, Alabama, Arizona, Arkansas, Colorado, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Michigan, Mississippi, Missouri, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Wisconsin, and Wyoming will be allowed to maintain their current residence and work remotely.Screening Question: How many cases have you typically reviewed in a day? Top 3-4 Required Skills: Utilization management experience, needs to be in the weedsNice to have Skills: NC License, Tech Savy, Excperience in government and commerical marketsYears of Experience: 7+ years Education/Certifications Required: MD or DO from accredited medical school Industry Specific Experience – Healthcare InsuranceBreakdown of Duties/Typical Day: Transactional work, would be responsible for all lines of business, Commercial, MA, FEP, and Appeals. Would cover call on the weekend (minumal could be once a month) Peer to Peer - call providers and have a discussion on any denials. The application of a Medical Director’s knowledge and clinical skills will vary across the Health Care division, dependent on focus areas identified by the business area supported.Leadership Skills:Project planning and managementCore Skills:Strategy Develops, collaborates and/or drives strategy and approach for varied Health Care and/or organizational initiatives (i.e. sales management strategies, behavioral health strategies, new health care delivery strategies)Operations Medical reimbursement and policyCare management (utilization management, case management, PA, appeals)Healthcare programs (disease management, Moonshots)Network support (Credentialing)Quality model design and analysisPartnership Develop strategic partnerships with internal business partners and external clients to support value based agreements and drive better consumer and provider experience.Takes a lead role in outreach and relationship building across the community (i.e. providers, health systems, community partners, members, etc).Evaluate and manage new and/or existing vendors and solution partners to align to BCNC’s strategic directionOngoing provider engagement functionsData gathering, management and analysis Evaluate clinical and other data to identify opportunities for improvement in health outcomes and financial performanceDiscuss data and performance with providers, employers, accreditors and regulators as needed.Communications Represent BCNC through delivery of presentations, speaking engagements and leadership of advisory groups with external audiences related to health care transformation and BCNC’s initiatives.Publish high impact content focused on improving accessibility, quality and affordability.Innovation Payment model designIdentify market trends that should influence key investments (new technologies, best practices).Evaluation of investment/partnership opportunitiesHiring RequirementsMD or DO from an accredited medical school and completion of residency training program.7+ years of experience in related fieldSome relevant experience outside of clinical practice is also required Current North Carolina medical licenseBoard certification in ABMS/AOA recognized clinical specialty is requiredEEO: “Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of – Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans.”