Job Description

Awarded the Best Place to Work 2021, Blue Cross Blue Shield of Arizona helps to fulfill its mission of improving the quality of life of Arizonans by delivering a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions.

This position is remote/hybrid within the state of AZ only

Medical Director - Medicaid Segment (Board Certified Psychiatrist)

Blue Cross Blue Shield of Arizona (BCBSAZ) is urgently hiring a full-time Medical Director to provide professional oversight for medical management activities related to utilization management, performance improvement, case management, disease management, and quality management activities.

In this role, you will support collaborative relationships with physicians and hospitals to achieve mutually acceptable business goals and ensure medical policies, procedures, and the activities/actions of the division on behalf of the corporation are consistent with the standards of good medical practice in the community.

Along the way, as you work to help us improve the quality of life for Arizonans, expect to thrive in an energetic, diverse environment, championed by an organization consistently named a Best Places to Work and Most Admired Company in Arizona.

Inspiring Health in Arizona Starts with You

Our benefits support work-life balance and the flexibility you need to be your best.

They include:

  • Remote, in-office, and hybrid work options within the state of Arizona
  • Eleven (11) paid holidays, including a floating holiday you can use any time you wish
  • Accrued paid time off (up to 16 days per calendar year)
  • Comprehensive medical, dental, and vision coverage
  • 401(k) up to 5% dollar-per-dollar match, 2% non-elective employer contribution
  • Up to 12% annual bonus based on corporate goals and individual performance
  • Eight (8) paid volunteer hours to support our mission of inspiring health
  • Tuition reimbursement for you; scholarship opportunities for your children
  • Employee discounts, gym reimbursement, and wellness programs
  • Treadmill desks, full-service fitness center, onsite cafeterias
  • Ongoing training for employees who wish to grow in their careers, acquire skills, and become managers
  • Potential flexible schedule

To thrive in this job, you must be able to:

  • Provide direction, support, and medical expertise and oversight to areas within the Health Services division, including utilization management, quality management, case management, performance improvement projects, medical claims review, and pharmacy management. Specific activities include outcome analysis, HEDIS, dispute resolution, regulatory compliance, care and disease management, concurrent review, precertification, medical claims reconsideration, and retrospective review.

  • Provide consultative services throughout the corporation for the Marketing, Sales, Legal, Actuarial, Network Management, Internal Audit, Finance, and Claims divisions.

  • Seek to improve department/division efficiency through effective use of information system tools and processes to reduce healthcare costs, increase quality of care and service, and reduce administrative expenses.

  • Review and implement medical policies and other medical decision-making policies or procedures.

  • Provide professional oversight for the various clinical peer committees, including the Clinical Quality Improvement, Credentialing, Medical Directors, and Medical Management committees.

  • Participate in the appeals and grievance process to ensure timely and accurate responses to members and providers.

  • Provide written information to members and providers through letters and articles in member and provider newsletters and other publications.

  • Foster productive relationships with all customers, employers, members, and providers to ensure members receive the appropriate health care in the most appropriate setting and with the best value.

We are looking for someone who can:

  • Communicate with customers regarding difficult and costly cases, including providing recommendations and showing the impact of BCBSAZ interventions.

  • Represent BCBSAZ at professional organizations, acting as liaison with individual health care professionals and supporting collaborative relationships with physicians and hospitals.

  • Contribute to departmental and cross-functional teams to achieve BCBSAZ goals and ensure future success.

  • Monitor quality performance measures, develop and maintain effective workflows, and seek to maximize system efficiencies.

Qualifications

  • Three (3) years of experience in a clinical setting
  • One (1) year of experience in a physician leadership role, including quality review, utilization review, and other managed care functions
  • Medical Degree
  • Active, current, and unrestricted license to practice medicine in the State of Arizona
  • Board Certification
  • Intermediate PC proficiency

Why Join Blue Cross Blue Shield of Arizona?

At BCBSAZ, your pursuit of balance, happiness, and fulfillment is supported through our Workability model. Workability is our future hybrid workforce strategy and defines where and how we do our jobs: 100% remote, 100% in the office or somewhere in-between.

No matter where you choose to work, we want you to be well. Our award-winning healthy campus in Phoenix is always available to you. Access telehealth services at our BlueCare Anywhere kiosk, fuel up with healthy meals and snacks at our cafeterias and Work Perks Café, and make the most of our onsite fitness center by taking advantage of personal trainers, a nutritionist, Health Support programs, and daily group fitness classes, including spin, yoga, and Zumba.

About Us

Blue Cross Blue Shield of Arizona (BCBSAZ) is committed to helping Arizonans get healthier faster and stay healthier longer. With a mission to inspire health and make it easy, BCBSAZ offers health insurance and related services to more than 1.9 million customers. BCBSAZ, a non-profit company, is an independent licensee of the Blue Cross Blue Shield Association. The company and its subsidiaries employ more than 2,500 people in its Phoenix, Flagstaff, and Tucson offices.

Our Commitment

BCBSAZ does not discriminate in hiring or employment on the basis of race, ethnicity, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status or any other protected group.

 

Our Commitment

BCBSAZ does not discriminate in hiring or employment on the basis of race, ethnicity, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status or any other protected group.

Thank you for your interest in Blue Cross Blue Shield of Arizona.  For more information on our company, see azblue.com.  If interested in this position, please apply.

Application Instructions

Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!

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