The French Group has been retained by Blue Cross and Blue Shield of North Carolina (BCBSNC) to recruit a Medical Director. BCBSNC is a leader in delivering innovative health care products, services and information to nearly 3.7 million members.
SUMMARY OF POSITIONThe Medical Director will work closely with the existing team of talented physician executives and will routinely interface with other teams such as medical policy, care management, pharmacy, network, sales and medical informatics. She/he will be responsible for making medical necessity and other benefit coverage determinations in compliance with medical policies, protocols, product designs, and professional judgment. The Medical Director will make recommendations for clinical product and program development, including providing medical advice, input, and support to the full spectrum of Member Health Partnership Operations. She/he will also collaborate with local area medical leaders as needed and assist with the development of provider networks and partnerships.The Medical Director reports to the Senior Medical Director, a seasoned physician executive with a calm demeanor and approachable, team-oriented management style. BACKGROUND/EXPERIENCE DESIREDThe Medical Director is a critical medical and business leader and contact for external providers, plan sponsors, and regulatory agencies; thus requiring superior interpersonal, negotiation, influencing and presentation skills. The successful candidate will also have the respect of her/his peers and credibility as a clinician with extensive experience in private practice. REQUIREMENTSM.D. or D.O. with active, unrestricted North Carolina medical license Current Board Certification in an ABMS recognized specialty Graduate degree or equivalent in healthcare management, finance or leadership preferredAt least three years experience in managed care, utilization review and/or quality management is desirable.5 years clinical experience after the completion of residency training program is required.