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Medical Director

Company: BlueCross BlueShield of Tennessee, Inc.
Location: Memphis
Posted on: September 12, 2020

Job Description:

Provides clinical leadership and serves as an internal medical consultant to various divisions and committees to support the development, implementation and monitoring of medical management and quality improvement activities. Job Description:

Job Responsibilities

Develop and administer inter-reviewer reliability methodology to ensure medical necessity determinations are consistent with CMS published guidelines corporate medical review criteria, and medical policy guidelines.

Analyze, evaluate and apply clinical metrics that produce actionable information in support of medical management and quality improvement initiatives.

Direct and support physician review to ensure timeliness, accuracy and reliability of UM and Appeals reviews.

Lead and serve on various committees in order to accomplish medical utilization, cost and quality objectives of BCBST.

Willingness to travel within the State of Tennessee and nationally.

Job Qualifications


Current MD or DO degree with an unencumbered and unrestricted license to practice medicine in Tennessee required. *However, this requirement can be waived for jobs where the totality of the incumbents duties and responsibilities are restricted to the performance of administrative duties only.


5 years - Clinical experience required

5 years - Healthcare administration, including UM experience required


Board Certification in a recognized specialty by the American Board of Medical Specialties or the American Board of Osteopathic Specialists

Ability to conceive and deliver innovative solutions

Ability to work independently with minimal supervision or function in a team environment sharing responsibility, roles and accountability.

Outstanding negotiation, presentation, and facilitation skills

Proficient in Microsoft Office (Outlook, Word, Excel and Powerpoint)

Ability to interpret and explain complex government policies

Knowledge of Medicare programs

Job Specific Requirements:

Specialty experience in Oncology, Infectious Disease or Pulmonary medicine preferred

Oncology experience highly preferred

Employees who are required to operate either a BCBST-owned vehicle or a personal or rental vehicle for company business on a routine basis* will be automatically enrolled into the BCBST Driver Safety Program. The employee will also be required to adhere to the guidelines set forth through the program. This includes, maintaining a valid driver’s license, auto insurance compliance with minimum liability requirements; as defined in the “Use of Non BCBST-Owned Vehicle” Policy (for employees driving personal or rental vehicles only); and maintaining an acceptable motor vehicle record (MVR).

*The definition for "routine basis" is defined as daily, weekly or at regularly schedule times.

Number of Openings Available:

1 Worker Type:

Employee Worker Sub-Type:

Regular Company:

BCBST BlueCross BlueShield of Tennessee, Inc. Applying for this job indicates your acknowledgement and understanding of the following statement:

BCBST is an Equal Opportunity employer (EEO), and all employees and applicants will be entitled to equal employment opportunities when employment decisions are made. BCBST will take affirmative action to recruit, hire, train and promote individuals in all job classifications without regard to race, religion, color, age, sex, national origin, citizenship, pregnancy, veteran status, sexual orientation, physical or mental disability, gender identity, or any other characteristic protected by applicable law.

Further information regarding BCBST's EEO Policies/Notices may be found by reviewing the following page:

BCBST's EEO Policies/Notices

BlueCross BlueShield of Tennessee is not accepting unsolicited assistance from search firms for this employment opportunity. All resumes submitted by search firms to any employee at BlueCross BlueShield of Tennessee via-email, the Internet or any other method without a valid, written Direct Placement Agreement in place for this position from BlueCross BlueShield of Tennessee HR/Talent Acquisition will not be considered. No fee will be paid in the event the applicant is hired by BlueCross BlueShield of Tennessee as a result of the referral or through other means.

Tobacco-Free Hiring Statement

T o further our mission of peace of mind through better health, effective 2017, BlueCross BlueShield of Tennessee and its subsidiaries no longer hire individuals who use tobacco or nicotine products (including but not limited to cigarettes, cigars, pipe tobacco, snuff, chewing tobacco, gum, patch, lozenges and electronic or smokeless cigarettes) in any form in Tennessee and where state law permits. A tobacco or nicotine free hiring practice is part of an effort to combat serious diseases, as well as to promote health and wellness for our employees and our community. All offers of employment will be contingent upon passing a background check which includes an illegal drug and tobacco/nicotine test. An individual whose post offer screening result is positive for illegal drugs or tobacco/nicotine and/or whose background check is verified to be unsatisfactory, will be disqualified from employment, the job offer will be withdrawn, and they may be disqualified from applying for employment for six (6) months from the date of the post offer screening results.

Resources to help individuals discontinue the use of tobacco/nicotine products include or 1-800-QUIT-NOW.

Posted 30+ Days Ago

Full time


About Us About Us

As Tennessee's largest health benefit plan company, we've been helping Tennesseans find their own unique paths to good health for over 65 years. More than that, we're your neighbors and friends – fellow Tennesseans with deep roots of caring tradition, a focused approach to physical, financial and community good health for today, and a bright outlook for an even healthier tomorrow.

Keywords: BlueCross BlueShield of Tennessee, Inc., Memphis , Medical Director, Other , Memphis, Tennessee

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