Medical Director Medical Policy

Blue Cross Blue Shield of Michigan • Detroit, MI

9d

About The Position

Provides clinical program leadership and develops, implements and approves policies within recognized area of responsibility.

Requirements

• Doctorate from an accredited school of medicine (M.D.) or osteopathy (D.O) required.
• Seven (7) years clinical practice experience.
• 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.
• Proven leadership, problem solving, and the ability to manage multiple priorities.
• Strong teaching and communication skills.
• 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.
• Other related skills and/or abilities may be required to perform this job.

Nice To Haves

• Specialty Care Knowledge is preferred.
• Medical Policy Experience is a plus.

Responsibilities

• Develop and maintain medical policy. Establish rationale for approving inquiries and appeals.
• Assists with clinical research, writing documents, and documenting decisions.
• Provide utilization management for prior authorization procedures. Review cases and make decisions based on medical policy.
• Provide clinical support to various areas of the organization. Process requests for clarification, interpretation, or questions about policy or benefits. Review potential impacts of clinical matters.
• Serves as clinical resource and subject matter expert to both clinical and non-clinical staff.
• Perform clinical reviews and conduct peer to peers.
• Participate in JUMP committee meetings.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Education Level: Ph.D. or professional degree