Medical Director, Utilization Management - Commercial Prior Authorization Review
About The Position
The Medical Director, Utilization Management – Commercial Prior Authorization Review will report to the Senior Medical Director, Utilization Management. In this role, you will deliver and collaborate on clinical review activities, which includes management of the physician processes in support of utilization management and transactional functions for BSC Commercial and Medicare members. These functions include performance of pre-service and retrospective utilization review, and operationalization of joint initiatives supporting BSC strategic goals. Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow – personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.
Requirements
- Medical Director, Utilization Management - Commercial Prior Authorization Review role.
- Report to the Senior Medical Director, Utilization Management.
- Deliver and collaborate on clinical review activities.
- Manage physician processes in support of utilization management and transactional functions for BSC Commercial and Medicare members.
- Perform pre-service and retrospective utilization review.
- Operationalize joint initiatives supporting BSC strategic goals.
- External hires must pass a background check/drug screen.
- Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance.
- All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.
Nice To Haves
- Leaders that are energized by creative and critical thinking.
- Leaders that are energized by building and sustaining high-performing teams.
- Leaders that are energized by getting results the right way.
- Leaders that are energized by fostering continuous learning.
Responsibilities
- Deliver and collaborate on clinical review activities.
- Manage physician processes in support of utilization management and transactional functions for BSC Commercial and Medicare members.
- Perform pre-service and retrospective utilization review.
- Operationalize joint initiatives supporting BSC strategic goals.
Benefits
- Opportunities for people to grow – personally, professionally, and financially.
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What This Job Offers
Job Type
Full-time
Career Level
Manager
Education Level
No Education Listed
