Associate Medical Director

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.

Southfield, 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.

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Competitive Compensation and Benefits Package

Overview: Provides clinical program leadership and implements, develops and approves policies within a recognized area of responsibility.<br /> <p style="font-weight: 400;"><strong>Departmental Preferences:</strong></p> <p style="font-weight: 400;">Provide medical leadership and clinical expertise for various areas and functions across the enterprise including utilization management, care management, quality management, pharmacy, credentialing, provider affairs, customer service, claims editing and compliance. Responsible for corporate and medical policy interpretation, recommendation, and review within recognized areas of responsibility. Advise and collaborate with colleagues, directors, and leadership in the development of clinical programs. Support Senior Health Services and Health Plan Business and other key business units. Compliance with regulatory and accreditation organizations.&nbsp;</p> <p style="font-weight: 400;">Responsible for supporting various departments and lines of business within the enterprise such as: HMO, Medicare, Commercial, Senior Health Services (Medicare), Utilization Management, Clinical Management, Pharmacy, and Care Management/Case Management.&nbsp;&nbsp;Responsible for department-specific metrics.</p>
Responsibilities: <ul> <li>Provide high-level clinical program oversight. Implement, develop and approve policies within a recognized area of responsibility.</li> <li>Develop strategic and operational plans for areas with input and review from executive leadership. Execute strategic initiatives.</li> <li>Identify larger scope of business opportunities.</li> <li>Impact the performance of BCBSM including short term effects on profitability, delivery of service and overall performance of assigned area; decisions may have long term effects.</li> <li>Other duties as assigned.&nbsp;</li> </ul> <ul> <li>Provide clinical support and participate in utilization management, quality management, and care management programs in the respective areas and identify opportunities for improvement and efficiency.</li> <li>Provide clinical leadership for health promotion and education programs.</li> <li>Provide clinical leadership for claims editing department.</li> <li>Assist in establishing corporate and regional programs to enhance quality of care, reduce medical costs and achieve positive health outcomes.</li> <li>Assist CMO/VP and professional staff in the design, development, implementation and assessment of disease state management and health enhancement programs that support the appropriate use of clinical resources in the delivery of consistent high-quality medical care.</li> <li>Develop and implement operational plans that are aligned with the strategic initiatives for recognized area of responsibility using board technical knowledge. Impact quality, cost, service and efficiency of area with significant impact on and accountability for performance of recognized area of responsibility.</li> <li>Serves as clinical resource and subject matter expert to both clinical and non-clinical staff.</li> <li>Perform clinical reviews and conduct peer to peers.</li> <li>Conduct discussions with physicians in the BCBSM network regarding: medical policies, utilization management, claims editing, use of resources and quality.</li> <li>Perform high dollar claims and complex case reviews.</li> <li>Participate in inter-rater reliability activities.</li> <li>Provide clinical/coding expertise for Corporate and Financial Investigations.</li> <li>Participate in committees and workgroups to achieve department and corporate objectives.</li> <li>Represent medical affairs/medical management/utilization management in external meetings and initiatives are required.</li> <li>Represent BCBSM in regional, state and national organizations as needed.</li> <li>Comply with all regulatory, accreditation, security, and documentation standards.</li> </ul>
Requirements: <ul> <li>Doctorate from an accredited school of medicine (M.D.) or osteopathy (D.O.) required.</li> <li>Seven (7) years 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 Board of Medical Specialists or the American Board of Osteopathy.</li> <li>Certification in Utilization Review preferred.</li> <li>Knowledge of BCBSM, providers and 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>