Sr. Medical Director & Associate CMO, Quality and Affordability

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 (Hybrid)

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.

keywords: position summary,leadership,analysis,strategy,organization,teamwork,education,experience,license,certification,skills


Competitive Total Compensation Package

Overview: <strong>Responsible for providing leadership and broad strategic direction for one or more defined medical areas or functions. Responsible for corporate policy interpretation, recommendation and review within recognized area of responsibility.&nbsp;</strong>
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> <br /> <p>Department Summary / Preferences:</p> <p>1) Use an analytic, data driven approach combined with clinical knowledge/experience to help assess and define areas of opportunity for continued strategic evolution for the purpose of impacting cost of care and medical appropriateness of care.&nbsp;</p> <p>2) Partner with the IMPACT team to support evaluation of various areas of medicine ( radiology, GI, etc.) in examining and sizing opportunities and looking at various strategies and approaches ( ie: UM, payment policy, medical policy, network strategies) &ndash; ensuring alignment across the approach holistically.&nbsp; May also entail examining traditional vendors and vendor/providers as part of overall strategy.&nbsp;</p> <p>3) Work across the enterprise to collaborate with leaders for medical and network management, partnering with network providers across specialties to better understand areas of opportunity will also be critical component of developing future strategies.&nbsp;</p> <p>4) Act as critical medical leader for external providers and plan sponsors, including regulatory &amp; accrediting agencies, and healthcare community in general.</p> <p>5) Lead efforts for improving and maintaining positive relations with providers, facilities, customers and consultants; supports sales and marketing efforts including participation in key marketing activities and presentations.</p>
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.</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 /><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>