Medical Director - Medical Policy (Medicare)

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: Responsible for providing leadership and broad strategic direction in the area of Senior Services particularly PPO and HMO Medicare and Medicare Advantage lines of business. Responsible for corporate policy interpretation, recommendation and review within recognized area of responsibility.
Responsibilities: <ul> <li>Provide high level oversight, leadership and direction for one or more defined medical areas or functions.</li> <li>Interpret, recommend and review corporate policy within recognized area of responsibility.</li> <li>Refine conceptual framework and provide broad strategic direction.</li> <li>Develop and approve strategic and operational plans for assigned units or area of responsibility.</li> <li>Impact the performance of BCBSM including short term as well as long term effects on major business units.</li> <li>Other duties as assigned.</li> </ul>
Requirements: <ul> <li>Doctorate from an accredited school of medicine (M.D.) or osteopathy (D.O.) required.</li> <li>Ten (10) year's recent clinical experience in area of specialization plus utilization review experience.</li> <li>Current unrestricted state of Michigan doctor of medicine (M.D.) or doctor of osteopathy (D.O.) license.</li> <li>Board certified or board eligible and working towards certification in a specialty approved by the American</li> <li>Board of Medical Specialists or the American Board of Osteopathy.</li> <li>Certification in Utilization Review preferred.</li> <li>Knowledge of BCBSM, providers, services and facilities preferred.</li> <li>Strong teaching and communication skills.</li> <li>Other related skills and/or abilities may be required to perform this job.</li> </ul> <br /> <p><strong>Departmental Preferences / Summary:</strong></p> <p>Five (5) years of experience and in utilization review with strong understanding of CMS regulations not limited to NCD and LCD, Medicare product cycle and benefit design requirements.</p>