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Regional Medical Director- (Nashville,TN)

Role overview

Summary

This role is for overseeing medical policies and programs at CareAllies. It integrates utilization review with population health and provider-performance initiatives, aiming to enhance quality and affordability in healthcare delivery.

Qualifications

  • Physician with a current and unrestricted physician license in a state or territory of the United States.
  • Maintain Board Certification as a M.D. or D.O. by an approved specialty board.
  • 5 years of clinical experience.
  • Analytical and communication skills.
  • Strategic thinking skills.

Responsibilities

  • Perform medical reviews and interact with provider communities for assigned areas.
  • Provide advanced clinical leadership across medical management programs.
  • Align medical policy expertise with clinical strategy to influence quality and market-level outcomes.

Key facts

Hard skills

Other skills

  • Analytical Skills
  • Verbal Communication Skills
  • Strategic Thinking
  • Team Leadership

About the company

Health Care Service Corporation logo

Health Care Service Corporation

  • Health Insurance & Payers
  • XLarge
  • 10,001+
Health Care Service Corporation, a Mutual Legal Reserve Company (HCSC), is an Independent Licensee of the Blue Cross and Blue Shield Association. We are the largest customer-owned health insurer in the United States, serving more than 18.6 million members through our Plans in Illinois, Montana, New Mexico, Oklahoma, and Texas. For nearly a century, we have enabled and coordinated the access to quality care for millions of members. Our experience and industry knowledge establishes a solid foundation for our future—driving innovations that further expand access, improve health outcomes, and reduce costs. Embedded within the fabric of how we operate is a deep sense of caring and commitment that informs how we serve our members, engage in local communities, and deliver positive change to the health care industry. As health care needs evolve, we leverage our portfolio of companies to deliver differentiated value to all industry stakeholders so that, together, we make more possible. Join HCSC and discover what new ways of thinking can mean for you, your community, our customers and our organization: HCSC.com/careers. We are an Equal Opportunity Employment / Affirmative Action employer dedicated to an inclusive, drug-free and smoke-free workplace. Drug screening and background investigation are required, as allowed by law. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, national origin, disability, or protected veteran status.

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Job description

At CareAllies, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers.

Job Summary

This position is responsible for assigned aspects of medical policies and programs. Performs medical reviews and interacts with the provider communities for assigned areas. Provides advanced clinical leadership across medical management programs, integrating traditional utilization review with strategic population health, value-based care, and provider-performance initiatives. Aligns medical policy expertise with forward-leaning clinical strategy to influence quality, Stars-related performance, affordability, risk adjustment accuracy, and market-level outcomes.

Required Job Qualifications:

  • Physician with a current and unrestricted physician license in a state or territory of the United States.
  • Maintain Board Certification as a M.D. or D.O. (by a specialty board approved by the American Board of Medical Specialties (doctors of medicine); or the Advisory Board of Osteopathic Specialists (doctors of osteopathic medicine)
  • 5 years of clinical experience
  • Analytical and communication skills
  • Strategic thinking skills

Preferred Job Qualifications:

  • Ability to travel
  • 3 years Managed Care experience
  • IPA (independent Physician Association) MSO or Value Based Enablement Organization Experience
  • Advanced skills in clinical interpretation, communication, data-driven strategy, and collaborative leadership
  • Experience with Stars performance, risk adjustment education, or provider engagement
  • Experience in matrixed environments and cross-functional clinical leadership.

R​emote work located in Nashville, TN


INAK

#LI-MG1

#LI-Remote

This position may be performed remotely from anywhere within the continental United States, excluding California, New York, Alaska, and Hawaii.

EEO Statement:

We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics. We are a drug-free and smoke-free workplace. Employment may be contingent upon successful completion of drug screening in accordance with applicable law.

Pay Transparency Statement:

At CareAllies, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, a minimum of 15 days’ of paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for full-time employees.

The salary offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan.

Min to Max Range:

$191,500.00 - $355,600.00

Exact compensation may vary based on skills, experience, and location.

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