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Chief Medical Officer

Chief Medical Officer

Blue Cross and Blue Shield of Kansas CityCalifornia, MO, United States
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Join us in a rewarding leadership role as we prioritize your success and wellbeing!

We offer a competitive total rewards package aimed at providing our employees with exceptional health, financial, and lifestyle benefits :

  • Comprehensive medical, dental, and vision benefits, along with a contributory 401(k) plan.
  • Incentive bonus opportunities based on organizational success.
  • Generous time off policy, including paid holidays, time off for volunteering, and paid vacation days.
  • Support for professional growth through development courses, mentorship, and tuition reimbursement.
  • Paid parental and adoption leave, including support for adoption expenses.
  • Exclusive employee discount program.

Position Summary : As the Chief Medical Officer, you will leverage your extensive clinical expertise to evaluate and determine the approval of requested services, levels of care, and service locations. You will work collaboratively with a small team of Medical Directors, utilizing clinical policies, state and federal regulations, and company contracts to inform your decisions.

Key Responsibilities :

  • Conduct thorough clinical reviews of complex medical cases, analyze clinical records, and engage in discussions with healthcare providers.
  • Assess overall data to identify opportunities for healthcare delivery improvement and enhance decision-making processes.
  • Utilize critical thinking skills to ensure quality care delivery while maintaining cost efficiency.
  • Exhibit active listening and empathy when navigating utilization review processes, particularly in challenging scenarios.
  • Analyze patient experiences to uncover care gaps and recommend both external and internal resources for resolution.
  • Expand your clinical knowledge across various specialties and collaborate with peers to ensure optimal decision-making.
  • Enhance quality and efficiency within our network by collaborating with providers and guiding them toward clinical initiatives.
  • Engage in utilization management and participate in medical appeals evaluations.
  • Offer medical guidance for quality management activities and participate in peer reviews of quality concerns.
  • Serve as a resource for various departments, including Sales, Legal, and Compliance, offering insight on clinical and utilization management issues.
  • Ensure compliance with NCQA, URAC, and other regulatory standards through medical leadership.
  • Facilitate communication between healthcare providers, patients, and the organization.
  • Handle inquiries related to customer service and claims effectively.
  • Minimum Qualifications :

  • M.D. or D.O. degree from an accredited medical school.
  • 5+ years of clinical patient care experience after residency or fellowship.
  • Board certification in an American Board of Medical Specialties (ABMS) specialty with ongoing certification.
  • Current unrestricted medical license in Missouri and Kansas or willingness to obtain upon hire.
  • Experience with quality and utilization improvement initiatives.
  • Strong verbal and written communication abilities.
  • No current sanctions from government organizations.
  • Proficiency in various technologies, including Microsoft products and EMRs.
  • Minimum 2 years of experience in utilization management, ideally in a managed care setting.
  • A passion for continuous learning, innovation, integrity, and a calm approach to change.
  • Familiarity with NCQA and URAC accreditation processes.
  • Experience with team leadership in hospital or industry settings.
  • Preferred Qualifications :

  • Advanced degree (MBA, MHA, MPH) or relevant certifications in administrative medicine.
  • Leadership experience in hospital committees or departments.
  • Familiarity with national clinical guidelines.
  • Clinical specialization in Internal Medicine, Family Practice, Geriatrics, Hospitalist, or Emergency Medicine.
  • Experience in the managed care industry and Medicare Advantage products.
  • Analytical skills demonstrated through involvement in quality management, utilization management, or related services.
  • We are an equal opportunity employer committed to creating an inclusive environment. All qualified applicants will be considered without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, status as a protected veteran, or disability.

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