Blue Cross Blue Shield of Wyoming

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!"