Medical Director, Utilization Management @ Blue Cross
Blue Cross and Blue Shield of Vermont is looking for a Medical Director, Utilization Management to join our Healthcare Informatics, Reimbursement and Management team. Our company culture is built on an unwavering focus on our members and giving them the best service possible. We offer a balanced, flexible workplace, an onsite gym, fitness and wellness programs, a competitive salary and full benefits package including medical and dental insurance, vision, 401k, paid time off and holidays, tuition reimbursement and student loan repayment, dependent caregiver benefits, and resources to support your ongoing personal and professional growth and development.
Hybrid Work: Blue Cross has transitioned to a hybrid workplace where employees within driving distance of our Berlin, VT office work Wednesdays in the office with flexibility to work remotely the rest of the week.
Medical Director, Utilization Management Responsibilities:
Responsible for performing initial clinical reviews for various service requests
Collaborate closely with the Utilization Management team and the Senior Medical Director to ensure that Utilization Management reviews are completed within the required timeframes set by the State and NCQA.
Conduct Provider-to-Provider (P2P) calls and manages medical policy and vendor relationships as needed.
Contribute to enhancing UM operations to improve efficiency and effectiveness.
Collaborate with the Quality, Case Management, and Provider Relations teams as needed.
Medical Director, Utilization Management Qualifications:
Based on leadership and infrastructure requirements of Vermont State Law, URAC, and NCQA, possession of an unrestricted Vermont medical license.
M.D. or D.O. degree.
Board certification in an American Board of Medical Specialties (ABMS) approved specialty.
5 years of clinical practice experience combined with 3 years of clinical management experience is required.
Prior medical administrative background is highly desirable.
Advanced management degree or equivalent preferred.
Must be a Vermont resident.
Medical Director, Utilization Management Benefits:
Health insurance (including vision)
Dental coverage (free to employees)
Wellness Program
401(k) with employer match + automatic employer contribution
Life Insurance
Disability Insurance
Combined time off (CTO) – 20 days per year + 9 paid holidays
Tuition Reimbursement
Student Loan Repayment
Dependent Caregiver Benefits