Sign up to access all features of our service.
  • Job search
  • Favorites
  • Create a CV
    New
  • Salaries
  • Subscriptions

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
Vacancy posted 17 hours ago
Similar jobs that could be interesting for youBased on the Medicare Advantage Medical Director: Policy & Quality in Louisiana, MO vacancy
  •  ...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... 
    Policy
    Contract work
    Work at office
    Local area
    Relocation

    Jobleads-US

    Louisiana, MO
    17 hours ago
  • $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... 
    Policy
    Weekly pay
    Full time
    Temporary work
    Remote work
    Weekend work

    Jobleads-US

    Louisiana, MO
    3 days ago
  • $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... 
    Policy
    Private practice
    Work at office
    Local area
    Work from home

    Jobleads-US

    Louisiana, MO
    17 hours ago
  • $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

    Blue Cross and Blue Shield of North Carolina

    Louisiana, MO
    5 days ago
  •  ...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... 
    Policy
    Remote job

    Jobleads-US

    Louisiana, MO
    17 hours ago
  •  ...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... 
    Policy
    Work at office
    Local area
    Immediate start
    Relocation

    Blue Cross and Blue Shield of Louisiana

    Louisiana, MO
    5 days ago
  • $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... 
    Policy
    Full time
    Remote work

    Cabana

    Louisiana, MO
    3 days ago
  •  ...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... 
    Policy
    Permanent employment
    Temporary work
    Work at office

    Saronic Technologies

    Louisiana, MO
    1 day ago
  • $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... 
    Policy
    Temporary work
    Work at office

    Socket.dev

    Louisiana, MO
    2 days ago
  •  ...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... 
    Policy
    Work at office

    Enfrasolutions

    Louisiana, MO
    5 days ago
  •  ...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

    Lake Charles Memorial Hospital

    Louisiana, MO
    5 days ago
  • 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... 
    Policy
    Full time
    Work at office

    Willis Knighton Health

    Louisiana, MO
    5 days ago
  • 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

    Vertex Pharmaceuticals

    Louisiana, MO
    3 days ago
  • 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

    Blue Cross and Blue Shield of North Carolina

    Louisiana, MO
    4 days ago
  • $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... 
    Policy
    Local area
    Flexible hours

    Zimmer Biomet

    Louisiana, MO
    17 hours ago
  • $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... 
    Policy
    Temporary work
    Work at office

    Specialty1 Partners

    Louisiana, MO
    1 day ago
  •  ...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 time
    Temporary work
    Local area
    Flexible hours

    Banfield

    Louisiana, MO
    3 days ago
  •  ...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... 
    Policy
    Full time
    Local area
    Flexible hours

    Kaizen Lab Inc.

    Louisiana, MO
    2 days ago
  •  ...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

    CVS Health Corporation

    Louisiana, MO
    5 days ago
  • $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

    Socket.dev

    Louisiana, MO
    5 days ago
  •  ...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. •... 
    Policy
    Temporary work
    Work at office

    CH01 CHE Fresenius Medical Care (Schweiz) AG

    Louisiana, MO
    4 days ago
  •  ...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

    Jobleads-US

    Louisiana, MO
    3 days ago
  • 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... 

    Direct Jobs

    Louisiana, MO
    5 days ago
  • # 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... 
    Relocation
    Relocation package

    Nejm

    Louisiana, MO
    4 days ago
  •  ...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 time
    For subcontractor
    Work at office

    Venture Global LNG

    Louisiana, MO
    19 hours ago
  • 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... 

    Nejm

    Louisiana, MO
    4 days ago
  • $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... 
    Policy
    Work at office
    Remote work
    Work from home
    Flexible hours

    Highmark Health

    Louisiana, MO
    3 days ago
  • $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 pay
    Local area
    Flexible hours

    BluePearl Pet Hospital

    Louisiana, MO
    3 days ago
  •  ...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 Group
    Policy

    UnitedHealth Group

    Bowling Green, MO
    5 days ago
  •  ...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 Optum
    Policy

    Optum

    Bowling Green, MO
    5 days ago

Do you want to receive more vacancies?

Subscribe and receive similar vacancies to Medicare Advantage Medical Director: Policy & Quality. Be the first to apply!