Mar 20, 2026
CareFirst BlueCross BlueShield
Resp & Qualifications PURPOSE: The Medical Director oversees all activities of utilization review, care management and quality to determine the medical effectiveness of proposed treatments and approve care management plans. The critical responsibility will be the management of care delivery in a cost effective and quality assured system that will assist the organization to achieve its corporate mission of serving the health needs of members. ESSENTIAL FUNCTIONS: Ensure that the provision of health care service to the membership is compliant with the medical policies and standards. Participate in medical necessity reviews, including pre-service reviews, concurrent reviews of inpatient and post-acute care, and appeals. Serves as key resource for network physicians for peer-to-peer case discussion. Provides clinical support for utilization review, care management and quality to determine the medical effectiveness of proposed...
Professional Diversity Network
Baltimore, MD, USA
Full-Time
