Independence Blue Cross LLC
Medical Director (Healthcare)
Bring your drive for excellence, teamwork, and customer commitment to Independence. Join us as we renew and reimagine the future of health care. Together we will achieve our mission to enhance the health and well-being of the people and communities we serve.
The Medical Director serves as a physician leader responsible for promoting the delivery of safe and effective medical care in the most cost effective way for the health plans offered by Independence Blue Cross and subsidiaries. There are multiple elements of discrete work that may fall under the role including:
The physician directly supports Utilization Management and Care Management and other business activities where involvement of a physician is determined to be in the best interest of Independence. The Medical Director will be responsible for rendering coverage and payment determinations based on the terms and conditions of the health plans for which Independence serves as claims administrator, and on the terms and conditions of contracts executed between Independence and networks of participating health care providers.
The Medical Director will exercise sound decision making based on clinical guidelines for best practices, a strong knowledge of clinical medicine, the practical realities of the delivery of health care in the state of Pennsylvania, and a thorough understanding of the principles of population health, quality management, patient safety and health insurance. The Medical Director will be expected to effectively collaborate with professional staff, senior leadership, management and associates and with external partners to promote the delivery of cost-effective health care across all lines of business.
Qualifications - External
Required Qualifications and Experience:
We require a Medical Doctor or Doctor of Osteopathy degree from a medical school or osteopathic medical school recognized by the American Association of Medical Colleges (AAMC), the American Osteopathic Association (AOA), or the World Health Organization (WHO).
Completion of an accredited residency program in a program accredited by the Liaison Committee of Graduate Medical Education (LCGME) or the AOA.
Has an unrestricted and unencumbered Pennsylvania or New Jersey licenses to practice clinical medicine or osteopathic medicine. Ability to successfully complete Independence Blue Cross credentialing process.