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Medical Director Utilization Management
Blue Cross Blue Shield of Michigan
Detroit, USA
Full-time
Director
Hybrid
Discovered 3 days ago
Full Job Posting
Qualifications
- Doctorate from an accredited school of medicine (M.D.) or osteopathy (D.O) required.
- Seven (7) years clinical practice experience.
- Two (2) years of previous medical director experience working for a health plan, medical group, or hospital in utilization management or medical management preferred.
- Current unrestricted state of Michigan Doctor of Medicine (M.D.) or doctor of osteopathy (D.O.) license.
- Board certified or board eligible and working towards certification in a specialty approved by the
- American Board of Medical Specialists or the American Board of Osteopathy.
- Certification in Utilization Review and Health Care Quality & Management is preferred.
- Ability to effectively communicate with external physicians and organizations.
- Proven leadership, problem solving, and the ability to manage multiple priorities.
- Results oriented and the ability to take ownership for initiatives and collaborate with cross-functional teams to achieve department and corporate goals.
- Demonstrated skill with Microsoft Office Suite and web-based programs.
- Understanding of health plan functions related to utilization, care, and quality management as well as HEDIS/STARs and NCQA. Familiarity with CMS regulations and standards.
- Basic knowledge of evidence-based clinical decision support guidelines (InterQual).
- Basic knowledge of CPT coding and guidelines.
- Other related skills and/or abilities may be required to perform this job.
- All qualified applicants will receive consideration for employment without regard to, among other grounds, race, color, religion, sex, national origin, sexual orientation, age, gender identity, protected veteran status or status as an individual with a disability.
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Preferred Qualifications
- Two (2) years of previous medical director experience working for a health plan, medical group, or hospital in utilization management or medical management preferred.
- Certification in Utilization Review and Health Care Quality & Management is preferred.
About Blue Cross Blue Shield of Michigan
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