Medical Director

September 15

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NJM Insurance Group

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Auto Insurance • Workers'​ Compensation Insurance • Homeowners Insurance • Commercial Auto Insurance • Renters Insurance

1001 - 5000

Description

• The Medical Director is a medical spokesperson for Horizon Blue Cross Blue Shield with the provider network across NJ • Accountable for providing leadership, direction and daily support for assigned region of NJ and assigned providers • Activities include utilization management, care management, disease management, quality management, pharmacy management, post service reviews, provider education, and clinical transformation • Responsible for a personal caseload of daily medical management activities and contributing to operational effectiveness of the medical management program • Supports the development and implementation of reimbursement policies

Requirements

• Requires Board Certification in an American Board of Medicine recognized specialty • Requires current unrestricted MD or DO license to practice medicine • Requires 5-7 years clinical experience with managing data to identify key issues, developing recommendations and providing content/conclusions to executive management • Proficiency working with Tableau or similar software required • Proficiency also required working with a Windows based environment including MS Office products • Continuous Improvement experience preferred • Active Unrestricted MD or DO license required; NJ license required; No CMS Sanctions or sanctions by other regulatory agencies or boards • Must be board certified by a specialty recognized by the American Osteopathic Association or the American Board of Medical Specialties

Benefits

• Comprehensive health benefits (Medical/Dental/Vision) • Retirement Plans • Generous PTO • Incentive Plans • Wellness Programs • Paid Volunteer Time Off • Tuition Reimbursement