The Medical Director will serve as a clinical subject matter expert responsible for supporting the plan utilization management, medical review and population health management programs across all lines of BCBS Kansas lines of business. As a clinical subject matter expert, the Medical Director may also provide support to plan programs including but not limited to medical policy development, quality management, and provider network management. This position requires a strong clinical background, leadership skills, and the ability to promote collaboration across functional areas to achieve organizational goals and objectives.

This position is eligible to work remote, hybrid or onsite in accordance with our Telecommuting Policy.

Why Join Us?

Make a Positive Impact: Your work will directly contribute to the health and well-being of Kansans.
Family Comes First: Total rewards package that promotes the idea of family first for all employees.
Dynamic Work Environment: Collaborate with a team of passionate and driven individuals.
Stability: 80 years of commitment, compassion and community.
Flexibility: Options to work onsite, hybrid or remote available.
Balance: Paid vacation and sick leave with paid maternity and paternity available immediately upon hire.
Inclusive Work Environment: We pride ourselves on fostering a diverse and inclusive workplace where everyone is valued and respected.

What you’ll do

Support utilization management and medical review activities including prior authorization, concurrent review, appeals processes, and claim review to ensure the appropriate use of healthcare services and resources. Provide clinical subject matter expertise to support medical necessity determinations and utilization review criteria.
Support the development and maintenance of medical policies, clinical guidelines, and coverage determinations based on evidence-based medicine. Ensure alignment with organizational goals, industry standards, and best practices.
Foster collaboration and communication among cross-functional teams, including medical directors, pharmacy, behavioral health, care management, and operations professionals to develop integrated care management strategies and improve care coordination.
Provide clinical subject matter expertise across all BCBSKS lines of business.
Provide clinical subject matter expertise as needed to support clinical programs and initiatives aimed at improving health outcomes, reducing costs, patient safety and enhancing member satisfaction. Analyze clinical data, identify opportunities for quality improvement, develop strategies to address gaps in care, reduce variation, and promote best practices.
Ensure compliance with state and federal regulations, accreditation standards, and health plan requirements related to utilization management, medical review, and medical policy. Stay abreast of changes in healthcare policy and reimbursement and implement necessary measures to maintain compliance.

Knowledge/Skills/Abilities

Commitment to evidence-based medicine, quality improvement, and healthcare innovation.
Effective oral and written communicator.

What you need

Medical degree (MD or DO) from an accredited institution.
Completion of residency training program in ABMS/AOA recognized clinical specialty.
ABMS/AOA board certification in a relevant medical specialty.
Active unrestricted medical license in a state to practice medicine, preferably in the state of Kansas.
5+ years of clinical experience.

Bonus if you have

Adult primary care specialty.
Experience with managed care/health insurance.

Benefits & Perks

Base pay is only one component of your competitive Total Rewards package.
Incentive pay program (EPIP).
Health/Vision/Dental insurance.
6 weeks paid parental leave for new mothers and fathers.
Fertility/Adoption assistance.
2 weeks paid caregiver leave.
5% 401(k) plan matching.
Tuition reimbursement.
Health & fitness benefits, discounts and resources.

Posting Close Date

Pay Rate Type Salary

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Blue Cross and Blue Shield of Kansas jobs

Medical Director