Medicare Advantage Medical Director: Policy & Quality
Jobleads-US
Blue Cross and Blue Shield of Louisiana Inc. seeks an experienced physician to serve as Medical Director, applying clinical judgment to utilization reviews and policy decisions. You will lead peer reviews, support accreditation efforts, and collaborate with providers across Louisiana.
Requirements include MD/DO with Louisiana licensure, ABMS board certification, and 7+ years of clinical practice with post-graduate patient care experience. Strong communication and leadership skills are essential.
#J-18808-Ljbffr Jobleads-US- ...by generally accepted medical evidence when formal guidelines... ...job: SENIOR MEDICAL DIRECTOR (MGR)Necessary... ...NCQA preferredMedicare Advantage experience is preferredSkills... ...knowledge of company policies and procedures.... ...internal operations such as quality assurance efforts, the...PolicyContract workWork at officeLocal areaRelocation
$223.8k - $313.1k
## Medical Director Behavioral Health, MedicaidApplylocations: Remote Nationwide: Remote Louisiana: Remote Indianatime type: Full timeposted... ..., which may include national clinical guidelines, state policies, CMS policies and determinations, clinical reference materials...PolicyWeekly payFull timeTemporary workRemote workWeekend work$227.6k - $385k
Medical DirectorSkip to main contentThank you for your interest in employment at a Highmark... ...permissible purposes.# CareersMedical Director page is loaded## Medical DirectorApplyremote... ...cases electronically and using Medical Policy criteria sets to evaluate the medical necessity...PolicyPrivate practiceWork at officeLocal areaWork from home$191.15k - $305.85k
...Job Description The Medical Director brings a unique set of knowledge and skills to the business... ...and our organizational pursuit of high quality and cost‑effective care for members.... ...) Operations Medical reimbursement and policy Care management (utilization management...Policy- ...Highmark Inc. seeks a Medical Director to lead utilization management within a physician-led team. You will review escalated cases against medical policy criteria, determine medical necessity, and participate in telephonic peer-to-peer discussions as needed. As part...PolicyRemote job
- ...for members enrolled in both Medicare and Commercial insurance plans... ..., Customer/Member services, medical case managers, primary care providers... ...case rounds and quality improvement initiatives. Actively... ...decisions based on established policies and procedures Comfortable...PolicyWork at officeLocal areaImmediate startRelocation
$120k - $160k
...is seeking a Senior Clinical Director to lead the development,... ...models, clinician workflows, policies, and clinical standards Serve... ...insurance requirements, including medical necessity, treatment planning... ...expanding access to high-quality mental health care...PolicyFull timeRemote work- ...seeking an experienced and driven Site Quality Manager to lead all Quality operations at... ...alignment with company-wide Quality objectives, policies, and ISO 9001 standards. Quality... ...g., office supplies, packages) Benefits Medical Insurance: Comprehensive health insurance...PolicyPermanent employmentTemporary workWork at office
$173.9k - $238k
...About The Role A key member of the Field Medical Marketing team who is aligned to a specific... ...best practices, working closely with the Director to optimize processes and procedures... ...BA degree in marketing, business, health policy, scientific or related field AND 10+ years...PolicyTemporary workWork at office- ...values—they are the pillars of our continued success. Overview As a Quality Control Manager, your role encompasses overseeing and managing... ...goals. This includes developing quality assurance policies, quality manuals, and ensuring adherence throughout the organization...PolicyWork at office
- ...ensuring accuracy in utilization management, and supporting high-quality patient care across behavioral health services. You will review... ...in care efficiency while maintaining compliance with policy and regulatory requirements. #J-18808-Ljbffr Lake Charles Memorial...Policy
- WK Medical Center Satellite Clinics SC-WK Vascular Surgery Shreveport, LA Full-Time, Day, 8-5 We are seeking a Clinic Manager for... ...actions and appearance. Orientation to Willis Knighton Health policies and protocols, as well as training on our practice management and...PolicyFull timeWork at office
- Vertex Pharmaceuticals seeks a State Government Affairs Director to drive regional public policy initiatives across multiple units, including policy, communications and medical affairs. You will build relationships with government officials and advocacy groups to advance...Policy
- Blue Cross NC seeks a Medical Director to bridge clinical leadership and strategic initiatives across the health care division... ...include strategy development, data‑driven quality improvements, payer policy and collaboration with internal partners. Requires MD/...Policy
$215k - $240k
...boundaries of innovation and driving our mission forward. As a global medical technology leader for nearly 100 years, a patient’s mobility is... .... Follow all internal communication and documentation policies (QA). Attend product trade shows and annual training as required...PolicyLocal areaFlexible hours$75k - $80k
...and healthcare regulations. Implementing quality controls and monitoring key performance... ...with standard OSHA and HIPAA practices and policies. If this describes you, you’ll fit right... ...aspects of your life, including: BCBS Medical & Dental insurance Options VSP Vision...PolicyTemporary workWork at office- ...play a pivotal role in our hospitals. Your medical practice management skills will be put... ...to your growth, you’ll be able to take advantage of a variety of educational opportunities... ...their time to delivering the highest quality veterinary care. Employment Type: Full-Time...Full timeTemporary workLocal areaFlexible hours
- ...that offers our certified nursing assistants flexible schedules, medical, dental, vision, 401(K), and paid time off (PTO) for both... ...professional standards of practice through physician orders, facility policies and procedures, and federal, state, and local guidelines. You...PolicyFull timeLocal areaFlexible hours
- ...Registered Nurse based in Louisiana. You will coordinate case management with members, evaluate medical needs, and promote overall wellness while adhering to network policies. The role requires active licensure, strong communication, and the ability to travel for field...Policy
$119k - $198.3k
...known for delivering insights, products, and services that make quality care more accessible and affordable. Here, we focus on the... ...additional information on McKesson’s full Equal Employment Opportunity policies, visit our Equal Employment Opportunity page. McKesson is...Policy- ...a Clinical Manager with Fresenius Medical Care, you will ensure that quality patient care is delivered while maintaining... ...career into an Area Team Lead or Director of Operations role.**Our culture:*... ...regarding company benefits, policies, procedures, and processes. •...PolicyTemporary workWork at office
- ...Humana Inc is seeking a Medical Director for Behavioral Health to oversee complex behavioral health care strategies. This remote position requires a Doctor of Medicine or Osteopathy and board certification in Psychiatry, along with extensive experience in clinical services...Remote job
- Direct Jobs is seeking a Medical Director to lead and shape a liver transplant program in Northern Louisiana, serving as the dominant referral... .... Responsibilities include creating clinical protocols and quality initiatives for growth, ensuring UNOS/OPTN compliance, and...
- # Transplant Hepatology | Medical Director | LouisianaEmployer: Jackson Physician SearchLocation: LouisianaPosted Date: Jul 22, 2026Reference... ...for Transplant Hepatology • Oversee clinical protocols, quality initiatives, and program growth • Fulfill all responsibilities...RelocationRelocation package
- ...as it allows for the same efficiency and operational reliability at significantly lower capital cost. We are looking for a Director, Project Quality to join our team in Cameron, LA. The ideal candidate will be responsible for the implementation of the project quality...Full timeFor subcontractorWork at office
- Jackson Physician Search in Louisiana seeks a Medical Director for Transplant Hepatology to lead a liver transplant program serving a wide referral base. You will oversee clinical protocols, quality initiatives, and program growth, with autonomy and support from a fully...
$27.02 - $41.85 per hour
...government programs such as Medicare Advantage (MA) and Affordable Care Act... ...Condition Category (HCC) Coding, medical coding, clinical terminology... ...physicians, team members, Quality, Compliance, partners at... ...Guidelines for Coding and Highmark’s Policy and Procedures to guide HCC...PolicyWork at officeRemote workWork from homeFlexible hours$88k - $120k
...on patient care. You will partner and oversee the doctor team, medical team, and client service representatives, guiding them to the next... ...career.To transform and lead the industry through innovative quality medicine and care, we understand the importance of continuous...Hourly payLocal areaFlexible hours- ...This role supports our mission to provide compassionate, high-quality hospice care and to connect patients, families and teams across... ...and coordinate the plan of care, and document patient progress while adhering to hospice policies. #J-18808-Ljbffr UnitedHealth GroupPolicy
- ...Hospice, a part of LHC Group. This role focuses on delivering high‑quality care in home settings while coordinating with an... ...assess needs, initiate and monitor the plan of care, document outcomes, and ensure adherence to hospice policies. #J-18808-Ljbffr OptumPolicy
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