Associate Medical Director

Blue Cross Blue Shield of Wyoming•Cheyenne, WY

86d•Hybrid

About The Position

An Associate Medical Director will be joining a dynamic experienced clinical team that provides quality health care as a health plan entity for the members of Blue Cross Blue Shield of Wyoming. Your core responsibilities include the aspects of utilization management as guided by medical policy for both medical and pharmacy benefits. Population Health is a new health plan endeavor that assists our members by case management, innovative health services, quality improvement projects and aspects of social determinants of health concerns. Our network of approved Wyoming licensed providers requires comprehensive credential reviews. An important expectation is to share your clinical expertise with a variety of departments at BCBS of Wyoming. Team collaboration begins with a strong working relationship with colleagues that comprise the Chief Medical Officer Department. You will be working closely with our nurse reviewers and clinical administrative staff. Inter-departmental interaction can include the provider network department, sales and marketing, data analytics and executive leadership. An understanding of our regulatory environment includes URAC Accreditation, legal compliance and Blue Cross Blue Shield Association governance. Our Clinical Quality Committee provides valuable input from our medical community. To be successful as an Associate Medical Director will require expansion of your physician skill set from a clinical base to a health plan concept. Evidence-based decisions will guide your application of medical policy to provide health care for our BCBS of Wyoming members. A greater proportion of your time will be focused on computer and information technology. Important interactions with the professional community exist with prior authorizations, peer-to-peer discussions and CME opportunities. Remote work is a consideration following completion of training. This position requires a greater proportion of time spent in the workplace to maximize collaborative working relationships.

Requirements

Graduate education from a School of Medicine or School of Osteopathy as defined by national accreditation standards.
Current, active, unrestricted license as an MD or DO from the Wyoming State Board of Medicine.
Current clinical board certification with Maintenance of Certification.
Minimum of five years post graduate clinical experience in direct patient care.
Confirmation of Wyoming residency, intent to become a Wyoming resident, or reasonable commuter distance if Colorado resident.

Nice To Haves

Administrative experience.

Responsibilities

Utilization management as guided by medical policy for both medical and pharmacy benefits.
Case management, innovative health services, quality improvement projects and aspects of social determinants of health concerns.
Comprehensive credential reviews for the network of approved Wyoming licensed providers.
Share clinical expertise with a variety of departments at BCBS of Wyoming.
Work closely with nurse reviewers and clinical administrative staff.
Inter-departmental interaction with provider network department, sales and marketing, data analytics and executive leadership.
Understand the regulatory environment including URAC Accreditation, legal compliance and Blue Cross Blue Shield Association governance.
Application of medical policy to provide health care for BCBS of Wyoming members.
Prior authorizations and peer-to-peer discussions.