Medical Director: MD or DO Required

At Blue Cross and Blue Shield of Nebraska, we are a mission-driven organization dedicated to championing the health and well-being of our members and the communities we serve.

Our team is the power behind that promise. And, as the industry rapidly evolves and we seek ways to optimize business processes and customer experiences, there’s no greater time for forward-thinking professionals like you to join us in delivering on it! As a member of Team Blue, you’ll find purpose, opportunities and the support you need to build a meaningful career and make a powerful impact in our community.

This position is a physician leader who will lead development and implementation of strategies that promote medical management, practice transformation, patient satisfaction, improvement to quality outcomes while reducing overall cost for the assigned area. The individual is responsible for enhancing relationships with providers, facilities, and internal/external partners to act as a project manager for the assigned medical management programs (e.g., utilization, prior authorization, case management, Medicare Advantage, etc.). Candidates applying to this position may be hybrid or remote and can live in one of the following states: Florida, Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota, and Texas.

What you'll do

• Provide clinical oversight of assigned area/s (e.g., utilization review/quality assurance, case management, quality, population health outcomes, and/or cost management).
• Conduct medical necessity reviews for utilization management appeals, including first- and second-level appeals, ensuring determinations are evidence‑based, clinically sound, timely, and compliant with applicable regulatory, accreditation, and plan requirements.
• Support the Medical Management staff and external partners to ensure timely and consistent responses to members and providers.
• Provide clinical expertise and business direction in support of medical management p