Associate Medical Director (Clinical Pharmacy)

<p>With more than 7,000 employees, we are the largest health insurance company in Michigan. We offer an exciting work environment with a diverse group of employees. Our goal is to make health insurance easier for our members. We want to transform the industry and become a resource that people can trust.</p>

Detroit, MI

Blue Cross Blue Shield of Michigan

When you think of <a href="" target="_blank" rel="noopener noreferrer">Blue Cross Blue Shield of Michigan</a> for health insurance, you can know you&rsquo;re getting much more. We're a company founded on a tradition of affordable, quality health care for everyone, improving the present and investing in the future.<br /><br />We offer:<br />Plans for employers and individuals that meet today&rsquo;s needs, budgets and lifestyle<br />The largest network of doctors and hospitals in the state<br />Lower health care costs Higher quality health care<br />Award-winning diversity practices<br />Grants and programs that promote better health throughout Michigan<br /><strong><br />Mission:&nbsp;</strong>We commit to being our members&rsquo; trusted partner by providing affordable, innovative products that improve their care and health.<br /><br /><a href="" target="_blank" rel="noopener noreferrer"><strong>Click here</strong></a> to learn more about our commitment to our Social Mission, view company updates and reviews, and view our awards &amp; accolades.<br /><br />Learn more about your options as an external candidate. <a href="" target="_blank" rel="noopener noreferrer">Click here</a> to view open positions.

keywords: medical,medical,compliance,analysis,support,performance,quality assurance,strategy,network,certification,experience


Competitive Total Compensation Package

Overview: Medical Director of the Pharmacy area provides clinical leadership for a very wide and important range of activities
Responsibilities: <ul> <li>Policy development and Maintenance via the Pharmacy and Therapeutics Committee, Specialty</li> <li>Pharmacy Workgroup and as a liaison with the Joint Uniform Medical Policy Committee (JUMP).</li> <li>Provider Outreach: Works closely with community-based specialists in development of criteria.</li> <li>Appeals Support: Major resource for clinical pharmacists reviewing prior authorization cases and appeals.</li> <li>Direct Case</li> <li>Review: Inquiries and Appeals that cannot be approved by Clinical Pharmacy staff, must be reviewed by a physician. The Medical Director provides that support.</li> <li>Peer to Peer interaction with network providers to support inquiry and appeal review activities.</li> <li>Serve as key subject matter expert in support of a wide range of BCBSM/BCN Corporate areas including, but not limited to: Marketing, Medical Affairs, Office of the General Counsel and Corporate and Financial Investigations (CFI).</li> <li>Implements and interprets area-specific policies procedures internally in specific practice area<strong>.</strong></li> <li>Implement and interpret policies and procedures in specific practice area.&nbsp;</li> <li>Develop and implement operational plans that are aligned with strategic initiatives for recognized area of responsibility using broad technical knowledge.&nbsp;</li> <li>Impact quality, costs, service and efficiency of area.</li> <li>Significant impact on and accountable for performance of recognized area of responsibility.</li> </ul>
Requirements: <ul> <li><span style="font-size: small;">Doctorate from accredited school of medicine (M.D.) or osteopathy (D.O.) required.</span></li> <li><span style="font-size: small;">Five (5) years recent clinical experience in area of specialization plus utilization review experience, Current unrestricted state of Michigan doctor of medicine (M.D.) or doctor of osteopathy (D.O.) license.</span></li> <li><span style="font-size: small;">Board certified or board eligible and working towards certification in a specialty, approved by the AmericanBoard of Medical Specialists or the American Board of Osteopathy, to be obtained within four years of hire</span></li> <li><span style="font-size: small;">Certification in Utilization Review preferred.</span></li> <li><span style="font-size: small;">Prior history working with Pharmacy professionals is preferred.</span></li> </ul> <div><em>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.</em></div>