This position is responsible for planning and implementation of medical policies and programs and strategic involvement with the cost of health care for accounts with more than 800,000 federal employee members across 5 states. This position is primarily accountable for advising and implementing quality improvement initiatives, medical guidelines, management of high-cost claimants, 2nd level prior authorization and claim reviews and process improvements. In addition, to various degrees, this position will perform physician level review using applicable systems and maintain effective relationships with physicians, hospitals, and medical service companies to respond to and resolve problems, serving as the final decision maker for clinical determination. This position will also head projects to promote effective policy relative to the membership of the Federal Employee Program in partnership with the Blue Cross Blue Shield Association. Please note, this is a HYBRID position which requires in-office hours 3 times a week at the respective location.