Medical Director

Worldwide Insurance Services • King of Prussia, PA

4h • Hybrid

About The Position

At Blue Cross Blue Shield Global SolutionsSM (BCBS Global SolutionsSM), we make it easy for people and organizations to access and pay for healthcare abroad. By combining digital innovation with human-centered care, we go above and beyond for our customers and deliver an international healthcare experience that’s simple, efficient, and human. 

Whether our customers live, work, travel or study abroad, we give them the confidence and peace of mind to embrace every journey and say “yes” to new possibilities.

You are a mission-driven physician leader who thrives at the intersection of clinical excellence, collaboration and innovation. You are energized by meaningful work with global impact, bring proven experience in international healthcare delivery and are ready to shape the future of high-quality connected care for our members around the world.

You blend strategic leadership with hands-on clinical work. You want to guide daily medical operations, partner closely with providers and internal teams, and influence programs that improve quality, outcomes and member experience. You enjoy solving complex problems, leading with humility and building strong relationships across diverse teams and cultures. Teamwork comes naturally to you, and you value a wide range of perspectives. You also understand that healthcare and patient needs are constantly evolving, and embracing technology to meet those needs isn’t just exciting, it’s part of your DNA. 

Here’s the work you’ll be doing to shape the clinical experience of our global members: 

Requirements

• You are an MD or DO, board‑certified in primary care or a recognized patient‑care specialty, and hold an active, unrestricted U.S. medical license in good standing.
• You have at least 5 years of post-residency clinical experience with demonstrated progression in clinical leadership, case management, or utilization management roles in multiple healthcare delivery models (e.g., hospital systems, ambulatory settings, managed care, global health, or health insurance operations).
• You understand managed care, utilization review, or health insurance operations—ideally with exposure to international health insurance or global assistance models.
• You can demonstrate how you’ve incorporated technology (like AI-assistance and digital engagement platforms) and embraced innovation in clinical workflows 
• You understand the need for rotating shifts and flexibility to support clinical needs for our 24/7/365 operation 

Nice To Haves

• Bonus points if you’re based in the eastern time zone (strongly preferred) and speak at least one other language fluently, in addition to English

Responsibilities

• Direct physician-led case management teams across all lines of business to achieve organizational goals.
• Participate in daily clinical operations, including case reviews, medical necessity decisions and appeal assessments, collaborating closely with nurses and clinical staff as an interdisciplinary team.
• Partner with Senior Medical Director and Medical Directors to provide coverage or project support when needed.
• Represent our international clinical team in senior-level corporate projects and initiatives.
• Participate in provider network development, new market expansion and evaluation of provider performance.
• Serve as a trusted advisor to internal teams—including Medical Review Team, Contracting, Finance, Claims, the Global Service Center, and Special Investigations (FWA).
• Conduct prospective, concurrent and retrospective clinical reviews using evidence-based guidelines across medical and behavioral health conditions.
• Ensure compliance with URAC standards and quality requirements.
• Lead or support cross-functional teams in quality improvement, operational projects and implementations.
• Assist Underwriting with medical record reviews related to coverage eligibility determinations.
• Mentor and support the professional growth of clinical staff.
• Help foster a culture that is inclusive, proactive, collaborative and results driven.
• Build strong relationships with internal stakeholders, providers and external committees or workgroups on behalf of BCBS Global Solutions.
• Contribute to product design, strategic planning and sales/client management support.
• Identify opportunities for innovation across clinical programs, digital tools and global health initiatives.
• Help promote cost-efficient, high-quality care while enhancing provider engagement and member experience.

Benefits

• Competitive base pay + annual bonus 
• Competitive medical plans
• Telemedicine available
• Paid parental leave
• Employee assistance and wellness support 24/7
• Free international healthcare coverage
• Hybrid work model
• Work abroad arrangements available 
• Generous PTO accrual program with carry-over option
• 9 paid holidays in addition to one floating holiday and one volunteer day
• Tuition reimbursement
• Career/Learning and development opportunities
• 401(k) with generous company match
• Pet insurance offerings
• Identify theft and legal coverages available 
• Emphasis on well-being (Virtual well-being platform, monthly mindfulness events, and giveaways)

What This Job Offers

• Job Type: Full-time
• Career Level: Director
• Education Level: Ph.D. or professional degree