About the Opportunity:
As an experienced M.D.
or D.O.
in adult acute care setting(s), you will use evidence-based decision making to perform inpatient case reviews that are timely and clinically appropriate.
You will concisely, effectively, and consistently synthesize clinical information to document a clear summary of a medically necessary determination.
While case reviews are this role's primary priority and function, you will have the opportunity to make recommendations on efficiencies and innovations to ensure our members are getting appropriate and timely care based on their health plan coverage.
You will partner across the organization with other internal teams, such as Business Analytics, Claims, Operations, Actuarial, and BlueCard, to name a few.
Join us on this continuous journey as we make health care better for our members!
About You:
You are decisive and have a strong ability to influence internally and externally by appropriately and effectively presenting evidence-based medicine to support a determination.
Critical thinking, sound judgment, and decisiveness are key; however, you will be able to draw from your colleagues' subject matter expertise from various departments, to help make evidence-based prior authorization decisions.
You are collaborative by nature and are energized by the opportunity to work in a highly integrated and matrixed culture.
Managed care experience in a large commercial organization, such as at another Blue Cross & Blue Shield plan, a plus.
If this sounds like you, apply to our Medical Director-Inpatient Utilization Management opportunity today!
Iowa or South Dakota-based candidates preferred but open to remote for the right candidate.
This full-time position will also work a rotating on-call schedule for weekend and vacation reviews.
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