Medical Director

Worldwide Insurance Services•King of Prussia, PA

74d•Hybrid

About The Position

At Blue Cross Blue Shield Global Solutions (BCBS Global Solutions), 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. We are looking for a mission-driven physician leader who thrives at the intersection of clinical excellence, collaboration and innovation. This role is energized by meaningful work with global impact, brings proven experience in international healthcare delivery and is ready to shape the future of high-quality connected care for our members around the world. This is a working clinical leader who blends strategic direction and people leadership with active participation in daily case reviews, clinical decisions, case discussions and appeals. The ideal candidate will guide daily medical operations, partner closely with providers and internal teams, and influence programs that improve quality, outcomes and member experience. They will enjoy solving complex problems, leading with humility and building strong relationships across diverse teams and cultures. Teamwork comes naturally, and a wide range of perspectives are valued. The candidate will also understand that healthcare and patient needs are constantly evolving, and embracing technology to meet those needs is essential.

Requirements

MD or DO with board certification in primary care or a recognized patient care specialty.
Active medical license in good standing or ability to obtain a license in the required jurisdiction(s).
Clinical experience needed to independently perform utilization reviews and render medical necessity and coverage determinations.
Experience with international healthcare delivery, ideally including multi-country health systems, clinical governance, global assistance, medical evacuation or transportation medicine.
Ability to make thoughtful, efficient clinical decisions, balance quality with timely resolution and translate complex clinical information for audiences with different levels of expertise.
Understanding of managed care, utilization review, or health insurance operations—ideally with exposure to international health insurance or global assistance models.
Comfort with technology and digital-health tools and enthusiasm for innovation in clinical workflows, including AI-assisted clinical decision support, data analytics and digital-member engagement platforms.
Demonstrated experience leading projects, processes or cross-functional teams and ability to build consensus across clinical and business stakeholders.
Understanding that schedule flexibility and on-call work are required to support a 24/7/365 global operation, including occasional meetings or critical responsibilities outside normal working hours.

Nice To Haves

Based in the Eastern time zone (strongly preferred).
Speaks at least one other language fluently (particularly French, Spanish, Mandarin or Arabic), 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 and coverage decisions and expedited and standard appeal reviews, while collaborating closely with nurses and clinical staff.
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, provider relationship management, 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.
Monitor clinical-review consistency through Interrater Reliability activities and routine quality audits.
Provide clinical guidance to nurses and other clinical staff to support appropriate utilization, timely case resolution and efficient clinical decision-making.
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)