Blue Cross and Blue Shield of Minnesota

Associate Medical Director

Healthcare
5 - 7 years of experience
Job Overview by Ladders

Qualifications

  • Graduate education from an accredited School of Medicine or Osteopathy.
  • Active unrestricted MD or DO license 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.
  • Preference for candidates with administrative experience.

Responsibilities

  • Oversee utilization management for medical and pharmacy benefits.
  • Collaborate on population health initiatives and case management.
  • Conduct comprehensive credential reviews for providers.
  • Engage in inter-departmental collaboration across BCBS of Wyoming.
  • Guide evidence-based medical decision-making according to policy.
  • Participate in peer-to-peer discussions and prior authorization processes.
  • Contribute to quality improvement projects focused on social determinants of health.

Benefits

  • Best-in-class health insurance at minimal or no cost for employees.
  • 401(k) plan with employer contributions.
  • Paid time off (PTO) and 10 paid holidays annually.
  • Potential for monthly incentives and performance-based commissions.
  • Wellness programs and paid volunteer hours support community engagement.
  • Flexible dress code promoting comfort in the workplace.
Full Job Description


If our passion and purpose resonate with you, you may be who we are looking for. The role we are looking to fill:

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.

Qualifications include a graduate education from a School of Medicine or School of Osteopathy as defined by national accreditation standards. You must have a current, active, unrestricted license as an MD or DO from the Wyoming State Board of Medicine and current clinical board certification with Maintenance of Certification. We ask that you have a minimum of five years post graduate clinical experience in direct patient care and a preference for those with administrative experience.

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. Blue Cross Blue Shield of Wyoming is an equal opportunity employer offering a robust benefits package. BCBS of Wyoming has recently been recognized as a certified "Great Place to Work!"

BCBSWY Employees Enjoy:

Best-In-Class Health Insuranceat minimal to no-cost for BCBSWY employees! PLUS many other benefits along with highly competitive compensation!

Our compensation program is reviewed for competitive market match on an annual basis and employees are eligible for annual merit increases. Monthly incentives that are based on individual and company performance are also available to eligible employees and members of our Sales Team can realize generous performance-based commissions.

At BCBSWY our employees are provided best-in-class benefits to support their physical, financial, and emotional wellness. These benefits include medical, dental, vision, 401(k), life insurance, paid time off (PTO), 10 paid holidays in addition to PTO annually, plus 8 paid volunteer hours, various wellness programs, and a dress code of "Dress for Your Day!" which can mean jeans every day (depending on your role).

Serving Those Who Call Wyoming Home.

Our positions are all based in Wyoming. Depending on the department and the position, eligible employees may be offered limited In-Office/WFH flexibility (for those positions that are offered limited WFH, there will be a required number of In-Office days per week/month depending on department). Executive level employees are required to reside full-time in Wyoming.

Our Selection Process:

Typically includes the following (NOTE: process steps may differ depending on role applied for)

  • Review of your completed application and any additional submitted materials (e.g., cover letter, certifications, etc.) for minimum qualifications and skills alignment.
  • Confirmation of Wyoming residency, intent to become a Wyoming resident, or reasonable commuter distance if Colorado resident.
  • Recruiter Phone Screen.
  • Possible Self-Assessment and/or Questionnaire.
  • Initial interview with Hiring Manager.
  • Possible 2nd Interview with Hiring Manager and/or additional Team members.
  • Comprehensive Background Check.


About Blue Cross and Blue Shield of Minnesota

Blue Cross and Blue Shield of Minnesota is a nonprofit health plan that serves more than 2.9 million members in Minnesota and surrounding states. The company was founded in 1933 and has been providing health insurance for over 80 years. Blue Cross and Blue Shield of Minnesota offers a variety of health plans, including individual and family plans, Medicare plans, and employer-sponsored plans. The company is committed to improving the health of its members and the communities it serves through innovative programs and partnerships.
Learn more about Blue Cross and Blue Shield of Minnesota
Size
3,200 employees
Industry
Founded
1933

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