Physician Consultant

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="https://www.bcbsm.com/" 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="http://www.bcbsm.com/index/about-us/our-company.html" 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="https://bcbsm.taleo.net/careersection/2/jobsearch.ftl?lang=en" target="_blank" rel="noopener noreferrer">Click here</a> to view open positions. http://www.bcbsm.com

keywords: management,medical,relationships,education,departmental preferences,analysis,medical,management,achieve,experience,certification,knowledge,skills,education

Full-Time

Competitive Compensation and Benefits Package

Overview: <div><span style="font-family: Arial;">The Medical Director, Care Management is a physician who provides medical input, oversight, leadership and support to care management teams and members to ensure that care management activities are performed in accordance with evidence-based clinical standards and guidelines within the context of the Triple Aim (improved population health, improved patient experience, and reduced per capita cost). The Medical Director, Care Management is responsible for:</span></div> <br /><span style="font-family: Arial;"><span style="font-family: Arial;">Teaching, consulting and advising on issues related to coordination of care, care management, population health management, disease management, appropriate utilization of resources, medical necessity, compliance, and applicable regulations.&nbsp; Developing and maintaining collaborative relationships with care management teams, health plan members, providers, and the community that prioritizes the needs of the member. Ensuring that care management teams achieve identified goals related to care outcomes, quality, efficiency, and member experience.<br /><br /><span style="text-decoration: underline;"><strong>Departmental Preference:<br /></strong></span></span></span><strong><span style="font-family: Arial;">Care Management</span></strong> <ul> <li><span style="font-family: Arial;">Provide clinical support to nursing team leaders</span></li> <li><span style="font-family: Arial;">Conduct peer-to-peer physician conversations as needed</span></li> <li><span style="font-family: Arial;">Conduct regular interdisciplinary care team meetings, ensure follow-up activities are carried out, and regular reports are provided</span></li> <li><span style="font-family: Arial;">High-Cost Claimant (HCC) Review Unit</span></li> <li><span style="font-family: Arial;">Provide clinical support to nursing team leaders</span></li> <li><span style="font-family: Arial;">Conduct peer-to-peer physician conversations as needed</span></li> <li><span style="font-family: Arial;">Conduct regular interdisciplinary care team meetings, ensure follow-up activities are carried out, and regular reports are provided</span></li> </ul> <span style="font-family: Arial;"><strong>Clinical Account Management<br /></strong></span> <ul> <li>Regularly interact with employers and customers supporting the health care consultants during annual strategic discussions</li> <li>Represent the care management department in discussion with employers and customers</li> </ul>
Responsibilities: <ul> <li><span style="font-family: Arial;">Participates in the development and execution of evidence-based clinical protocols and guidelines&nbsp;&nbsp;</span></li> <li><span style="font-family: Arial;">This position will need to understand the commercial employer market, specifically the needs of self-funded employers</span></li> <li><span style="font-family: Arial;">Contributes to clinical decision-making processes through the application of medical knowledge and experience&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></li> <li><span style="font-family: Arial;">Identifies, directs, and executes continuous quality improvement activities to achieve identified quality/performance metrics</span></li> <li><span style="font-family: Arial;">Serves as a medical resource for information and consultation on issues related to clinical services</span></li> <li><span style="font-family: Arial;">Ensures that care management policies, procedures, processes, and functions are consistent with applicable standards and regulations</span></li> <li><span style="font-family: Arial;">Implements action plans as needed to achieve and enhance compliance with accreditation and other applicable standards/regulations</span></li> <li><span style="font-family: Arial;">Assists in the analysis, interpretation, and reporting of clinical data</span></li> <li><span style="font-family: Arial;">Presents progress reports, updates and data analysis to a wide range of audiences</span></li> <li><span style="font-family: Arial;">Provides consultation and staff education via clinical presentations and care management conferences</span></li> <li><span style="font-family: Arial;">Interacts effectively with members, practitioners/providers, and colleagues</span></li> <li><span style="font-family: Arial;">Mentors and coaches medical group providers as well as contracted providers as appropriate based on specific initiatives</span></li> <li><span style="font-family: Arial;">Identifies, develops and implements projects that align with the company&rsquo;s strategic goals</span></li> <li><span style="font-family: Arial;">Ensures that care management processes and procedures are aligned with business objectives</span></li> <li><span style="font-family: Arial;">Resolves and/or escalates issues in a timely manner</span></li> <li><span style="font-family: Arial;">Works effectively with existing or potential vendors</span></li> <li><span style="font-family: Arial;">Provides liaison to the utilization department to identify potential high-cost claimants</span></li> <li><span style="font-family: Arial;">Facilitates the work of the high-cost claim review unit</span></li> </ul>
Requirements: <ul> <li><span style="font-family: Arial; font-size: small;">Doctorate from an accredited school of medicine (M.D.) or osteopathy (D.O.) required.</span></li> <li><span style="font-family: Arial; font-size: small;">Five (5) years of recent clinical experience in the area of specialization plus utilization review experience.</span></li> <li><span style="font-family: Arial; font-size: small;">Current unrestricted state of Michigan doctor of medicine (M.D.) or doctor of osteopathy (D.O.) license.</span></li> <li><span style="font-family: Arial; font-size: small;">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, to be obtained within four years of hire.</span></li> <li><span style="font-family: Arial; font-size: small;">Certification in Utilization Review preferred.</span></li> <li><span style="font-family: Arial; font-size: small;">Master&rsquo;s degree in public or Population Health, preferred<br /></span></li> <li><span style="font-family: Arial; font-size: small;">Two years&rsquo; experience in medical management, population health management, care management, or utilization management.&nbsp;&nbsp;</span></li> <li><span style="font-family: Arial; font-size: small;">Demonstrated understanding of and experience with the commercial employer market, specifically the needs of self-funded employers.</span></li> <li><span style="font-family: Arial; font-size: small;">Knowledge of BCBSM, providers, services, and facilities.<br /></span></li> <li><span style="font-family: Arial; font-size: small;">Strong teaching, presentation, and communication skills.</span></li> <li><span style="font-family: Arial; font-size: small;">Other related skills and/or abilities may be required to perform this job.</span></li> </ul>