Medical Director Quality Mgmt

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.

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.&nbsp;<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 />For Application Timeline &amp; Selection Process:&nbsp;<a href="" target="_blank" rel="noopener noreferrer">Click Here</a>. Learn more about your options as an external candidate. <a href="" target="_blank" title="BCBSM" rel="noopener noreferrer">Click here</a> to view open positions.

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Competitive Total Compensation Package

Overview: Provides clinical program leadership and develops, implements and approves policies within recognized area of responsibility.
Responsibilities: <ul> <li> <div>Develop and maintain medical policy.&nbsp; Establish rationale for approving inquires and appeals.</div> </li> <li> <div>Assists with clinical research, writing documents, and documenting decisions.</div> </li> <li> <div>Provide utilization management for prior authorization procedures.&nbsp; Review cases and make decisions based on medical policy.&nbsp;</div> </li> <li> <div>Provide clinical support to various areas of the organization.&nbsp; Process requests for clarification, interpretation, or questions about policy or benefits.&nbsp; Review potential impacts of clinical matters.</div> </li> <li> <div>Serves as clinical resource and subject matter expert to both clinical and non-clinical staff.</div> </li> <li> <div>Perform clinical reviews and conduct peer to peers.</div> </li> <li> <div>Participate in JUMP committee meetings.</div> </li> </ul>
Requirements: <ul> <li> <div>Doctorate from an accredited school of medicine (M.D.) or osteopathy (D.O) required.</div> </li> <li> <div>Seven (7) years clinical practice experience.</div> </li> <li> <div>Current unrestricted state of Michigan Doctor of Medicine (M.D.) or doctor of osteopathy (D.O.) license.</div> </li> <li> <div>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.</div> </li> <li> <div>Proven leadership, problem solving, and the ability to manage multiple priorities.</div> </li> <li> <div>Strong teaching and communication skills.</div> </li> <li> <div>Results oriented and the ability to take ownership for initiatives and collaborate with cross-functional teams to achieve department and corporate goals.</div> </li> <li> <div>Demonstrated skill with Microsoft Office Suite and web-based programs.</div> </li> <li> <div>Understanding of health plan functions related to utilization, care, and quality management.</div> </li> <li> <div>Other related skills and/or abilities may be required to perform this job.</div> </li> </ul> <div id="gtx-trans" style="position: absolute; left: -130px; top: -20px;">&nbsp;</div>