At our organization, we are dedicated to fostering your success through our core values and employee benefits. We pride ourselves on offering a top-tier employee experience that includes: Competitive total rewards package, featuring comprehensive medical, dental, and vision benefits in addition to a 401(k) plan with contributions from both employee and employer. Annual incentive bonus based on the achievement of company goals. Paid time off including holidays, vacation time, and volunteer leave. Opportunities for professional development, mentorship programs, and tuition reimbursement. Paid parental and adoption leave, along with financial assistance for adoption. Employee discount program. Job Summary: The Chief Medical Director leverages clinical training, expertise, and judgment to determine the authorization of services, levels of care, and appropriate sites for medical services. They will apply clinical policies, regulatory guidance, and contractual obligations to inform their decisions while leading a small team of Medical Directors and contributing clinical insights to various organizational initiatives. Key Responsibilities: Conduct thorough reviews of moderately complex to complex clinical cases, including evaluating clinical records and engaging in peer discussions with healthcare providers. Analyze data to shape strategies aimed at enhancing healthcare delivery and optimizing decision-making processes. Utilize critical thinking skills to ensure high-quality care for members while maintaining cost-effectiveness. Exhibit active listening skills and compassion, navigating discussions where consensus may be difficult, particularly in utilization review situations. Examine individual member cases to pinpoint care gaps and available resources, participating in multidisciplinary discussions to ensure adherence to evidence-based practices. Maintain a broad medical knowledge base and a proactive attitude toward learning across various specialties, collaborating with others to reach prudent decisions. Enhance care quality and efficiency within the network while integrating providers into clinical initiatives. Manage utilization for medical, surgical, and pharmacy services. Oversee medical appeals, reviewing cases concerning necessity or investigational queries. Provide medical leadership on quality management initiatives, conducting peer reviews related to quality concerns. Act as a medical advisor across multiple areas within the organization including Sales and Marketing, Compliance, and Provider Services. Ensure conformity with standards from NCQA, URAC, and other accreditation bodies. Facilitate communication with physicians, hospitals, and community providers. Address customer service and claims inquiries as needed. Minimum Qualifications: M.D. or D.O. degree from an accredited medical school. Five or more years of direct clinical patient care experience post-residency or fellowship. Board certification in an approved American Board of Medical Specialties (ABMS) specialty, with ongoing certification during employment. Possession of a current, unrestricted medical license in Missouri and Kansas or a commitment to obtain upon hiring. Experience with quality and utilization improvement initiatives. Excellent verbal and written communication abilities. No current sanctions from any relevant governmental organizations; capability to meet credentialing standards. Proficiency with technology across various platforms, including Microsoft products and EMRs. A minimum of two years of experience in utilization management activities, preferably in a managed care environment. A commitment to continuous learning, innovation, and demonstrating integrity in all actions. Experience in preparation for NCQA and URAC accreditation. Experience managing clinical teams in healthcare settings. Preferred Qualifications: Advanced degree (MBA, MHA, MPH) or relevant certifications in administrative medicine. Leadership experience in a hospital committee or medical department. Familiarity with national guidelines (e.g., MCG, InterQual, CMS). Clinical focus in Internal Medicine, Family Practice, Geriatrics, Hospitalist, or Emergency Medicine. Three years of experience in the managed care industry, covering products like Medicare Advantage and integrated delivery systems. Experience overseeing medical aspects of Medicare Advantage products. Demonstrated analytical skills with involvement in quality management, utilization management, and case management teams. We are an equal opportunity employer at Blue Cross and Blue Shield of Kansas City. All qualified applicants will be considered for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, veteran status, or disability.