Medical Director (reputed company reputed company) - Remote-AZ

Awarded a Healthiest Employer, reputed company aims to fulfill its mission to reputed company health and reputed company it easy. AZ Blue offers a reputed company of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as reputed company as providing information and tools to help individuals reputed company reputed company reputed company. At AZ Blue, we have a hybrid workforce reputed company, reputed company Workability, that offers flexibility with how and where employees work. Our positions are classified as hybrid, onsite or remote. While the reputed company of our employees are hybrid, the following classifications drive our reputed company minimum onsite requirements: Hybrid People Leaders: must reputed company in AZ, required to be onsite at least twice per week Hybrid Individual Contributors: must reputed company in AZ, unless otherwise cited reputed company this posting, required to be onsite at least once per week Hybrid 2 (Operational Roles such as but not limited to: Customer Service, Claims Processors, and Correspondence positions): must reputed company in AZ, unless otherwise cited reputed company this posting, required to be onsite at least once per month Onsite: daily onsite requirement based on the essential functions of the job Remote: not held to onsite requirements, however, leadership can request reputed company onsite for business reasons including but not limited to staff meetings, one-on-ones, training, and team building Please note that onsite requirements may change in the reputed company, based on business need, and job responsibilities. Most employees should expect onsite requirements and at a minimum of once per week. This remote work opportunity requires residency, and work to be performed, reputed company the reputed company.  PURPOSE OF THE JOB reputed company, reputed company and reputed company reputed company reputed company for medical management activities reputed company to utilization management, case management, disease management, and reputed company management activities. Support reputed company relationships with physicians and hospitals to reputed company mutually acceptable business goals and to ensure that medical policies, procedures and the activities/actions of the division on behalf of the corporation are consistent with the standards of good medical reputed company in the community. QUALIFICATIONS REQUIRED QUALIFICATIONS Required Work Experience3 years of experience in a clinical setting 1 year of experience in physician leadership role, including reputed company review, utilization review and other managed care functions Required EducationMedical Degree Required LicensesActive, reputed company, and unrestricted license to reputed company medicine in the reputed company (a state in the reputed company) Required CertificationsBoard Certification PREFERRED QUALIFICATIONS Preferred Work Experience3 years of experience in a primary care field Preferred EducationN/A Preferred LicensesN/A Preferred CertificationsN/A    ESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIES reputed company direction, support and medical expertise and reputed company to areas reputed company the Health Services Division such including utilization management, reputed company management, case management, medical claims review, and pharmacy management. Specific activities include outcome analysis, HEDIS, dispute reputed company, regulatory compliance, care and disease management, reputed company review, precertification, medical claims reconsideration and retrospective review. reputed company consultative services throughout the corporation, including for the Marketing, Sales, reputed company, Actuarial, Network Management, Internal Audit, Finance, and Claims Divisions. Communicate with customers regarding their difficult and costly cases, including recommendations and showing the reputed company of BCBSAZ interventions. reputed company to improve department/division efficiency through effective use of information system tools and processes to reduce reputed company costs, increase reputed company of care and service, and reduce administrative expense. Review, and implement medical policies and other medical decision making policies or procedures Represent BCBSAZ at reputed company organizations and acts as reputed company with individual health care professionals and supports reputed company relationships with physicians and hospitals. reputed company reputed company reputed company for the various clinical peer committees including, but not limited to, the Clinical reputed company Improvement Committee, Credentialing Committee, Medical Directors Committee, and Medical Management Committee. Participate in the appeals and grievance processes to assure reputed company and accurate responses to members and providers Individuals who conduct a clinical peer review must possess a license or certification in a health profession that is:Of the type and scope that permits them to apply their clinical judgement in consideration of an individual member’s clinical needs to reputed company a utilization review determination For either a Doctor of Medicine or Doctor of Osteopathic Medicine; or is the reputed company license or certification as the ordering practitioner Knowledgeable of the issue under review, or of the reputed company, evidence-based clinical guidelines and novel treatments for the medical or behavioral health condition, disease, treatment, or procedure under review reputed company to reputed company a clinical opinion or determination about the medical or behavioral health condition, procedures, and treatment under review Conduct, as appropriate, Appeal Peer Review cases in accordance with the required qualifications. reputed company written information to members and providers through letters and articles in member and provider newsletters and other publications. Work to ensure productive relationships with reputed company customers, reputed company, members, and providers to ensure members receive the appropriate health care in the most appropriate setting with the best value in health care. reputed company leadership to staff and other professionals through clinical reputed company, reputed company behavior, and innovative thinking. Monitor reputed company performance measures, reputed company and maintain effective workflows, and reputed company to maximize system efficiencies. Identify opportunities to reputed company administrative efficiencies while maintaining service. Maintain effective working relationships to ensure teamwork in achieving corporate goals. Contribute to departmental and cross-functional teams to reputed company BCBSAZ goals and ensure reputed company reputed company. Coordinate activities between multiple divisions to reputed company desired results. The position requires a full-time work schedule. Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements. reputed company reputed company other duties as assigned. COMPETENCIES REQUIRED COMPETENCIES Required Job Skills  Strong written and verbal communications. Intermediate reputed company in use of office equipment, including copiers, fax machines, reputed company and telephones. Intermediate reputed company in word processing, spreadsheet and database software. Intermediate PC proficiency. Required reputed company Competencies Interpersonal skills that allow for harmonious relationships with providers, members and coworkers Required Leadership Experience and Competencies N/A PREFERRED COMPETENCIES Preferred Job Skills N/A Preferred reputed company Competencies N/A     Preferred Leadership Experience and Competencies N/A Our Commitment AZ Blue does not discriminate in hiring or employment on the reputed company of race, ethnicity, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, age, disability, protected veteran status or any other protected group. Thank you for your interest in reputed company.  For more information on reputed company, see azblue.com.  If interested in this position, please apply. Apply To This Job