Medical Director, Utilization Management Lead
20 hours ago
We are seeking a highly skilled Medical Director, Utilization Management to join our team at Blue Shield of California. The successful candidate will be responsible for leading our utilization management efforts, ensuring that our members receive high-quality, cost-effective care.
Key Responsibilities- Develop and implement utilization management strategies to improve quality and reduce costs
- Lead a team of clinical staff in conducting reviews of medical necessity and appropriateness of care
- Collaborate with stakeholders to develop and implement policies and procedures related to utilization management
- Provide clinical expertise and guidance to support the development of quality improvement initiatives
- Stay up-to-date with regulatory requirements and industry trends to ensure compliance and best practices
- Medical degree (M.D.) and completion of residency in adult-based primary care specialty (e.g. internal medicine, family practice)
- Active, unrestricted California State Medical License and ability to obtain licenses in other states as required
- Board Certification in one of ABMS or AOA categories (preferably internal medicine or family practice)
- Experience in utilization management, quality improvement, and clinical leadership
- Strong communication and collaboration skills
Blue Shield of California offers a competitive salary and benefits package, as well as opportunities for professional growth and development. We are committed to creating a diverse and inclusive work environment that values and respects the contributions of all employees.
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Medical Director, Utilization Management
2 hours ago
Rancho Cordova, California, United States Blue Shield of California Full timeJob SummaryBlue Shield of California is seeking a highly skilled Medical Director, Utilization Management to join our team. As a key member of our Medical Management department, you will play a critical role in ensuring our Medi-Cal members receive the right level of care, at the right time, and at the right cost.The ideal candidate will have a strong...
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Medical Director, Utilization Management
2 days ago
Rancho Cordova, California, United States Blue Shield of California Full timeAbout the RoleWe are seeking a highly skilled Medical Director, Utilization Management to join our team at Blue Shield of California. As a key member of our Medical Management department, you will play a critical role in ensuring our Medi-Cal members receive the right level of care, at the right time, and at the right cost.Key ResponsibilitiesReview and make...
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Medical Director, Utilization Management
2 days ago
Rancho Cordova, California, United States Blue Shield of California Full timeAbout the RoleWe are seeking a highly skilled Medical Director, Utilization Management to join our team at Blue Shield of California. As a key member of our Medical Management department, you will play a critical role in ensuring our members receive the right level of care, at the right time, and at the right cost.Key ResponsibilitiesReview and make...
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Director of Commercial Utilization Management
3 weeks ago
Rancho Cordova, California, United States Blue Shield of California Full timeAbout the RoleWe are seeking a highly skilled and experienced Director, Commercial Utilization Management to join our team at Blue Shield of California. This critical role will play a key part in the success of our Utilization Management department in achieving its goals and objectives.Key ResponsibilitiesDevelop and implement effective utilization...
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Medical Director, Utilization Management Specialist
11 hours ago
Rancho Cordova, California, United States Blue Shield of California Full timeAbout the RoleThe Medical Director, Utilization Management plays a critical role in ensuring the delivery of high-quality, cost-effective healthcare services to our members. As a key member of the Blue Shield of California Medical Management team, you will be responsible for reviewing and making determinations regarding member and provider requests for...
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Director of Commercial Utilization Management
3 weeks ago
Rancho Cordova, California, United States Blue Shield of California Full timeAbout the RoleWe are seeking a highly skilled and experienced Director, Commercial Utilization Management to join our team at Blue Shield of California. This critical role will play a key part in driving the success of our Utilization Management department and contributing to the organization's goals and objectives.Key ResponsibilitiesDevelop and implement...
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Medical Director Operations Lead
24 hours ago
Rancho Cordova, California, United States Blue Shield of California Full timeAbout the RoleBlue Shield of California is seeking a highly skilled Medical Director Operations Lead to provide clinical leadership within the Medical Management department. This role will oversee clinical review activities, including utilization management, appeals, and grievances. The successful candidate will have a strong background in healthcare...
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Rancho Cordova, California, United States Blue Shield of California Full timeAbout the RoleWe are seeking a highly experienced and skilled Director, Medicare & Medi-Cal Utilization Management to join our team at Blue Shield of California. This critical role will play a key part in delivering and collaborating on all aspects of utilization management and care coordination for our Medicare and Medi-Cal membership.Key...
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Rancho Cordova, California, United States Blue Shield of California Full timeAbout the RoleThe Director of Medicare and Medi-Cal Utilization Management will play a critical role in the success of Blue Shield of California and the Utilization Management department in realizing its goals and objectives.Key ResponsibilitiesDevelop and implement utilization management strategies to ensure timely and cost-effective care for patients.Lead...
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Medical Director Operations
3 weeks ago
Rancho Cordova, California, United States Blue Shield of California Full timeJob SummaryWe are seeking a highly skilled Medical Director to lead our CalPERS operations team. As a key member of our Medical Management team, you will be responsible for delivering and collaborating on clinical review activities, including management of physician processes in support of utilization management and transactional functions for CalPERS...
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Medical Director Operations
3 weeks ago
Rancho Cordova, California, United States Blue Shield of California Full timeYour RoleThe Medical Director Operations - CalPERS will play a pivotal role in ensuring Blue Shield of California's medical management team remains at the forefront of medical, medication, and payment policy innovation. Reporting to the Vice President Medical Management, this position will deliver and collaborate on clinical review activities, including...
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Utilization Management Nurse Senior
3 weeks ago
Rancho Cordova, California, United States Blue Shield Of California Full timeAbout the RoleWe are seeking a highly skilled Utilization Management Nurse, Senior to join our team at Blue Shield of California. As a key member of our Utilization Management team, you will play a critical role in ensuring our members receive high-quality, cost-effective care.Key ResponsibilitiesPerform prospective utilization reviews and first-level...
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Utilization Management Nurse Senior
2 days ago
Rancho Cordova, California, United States Blue Shield Of California Full timeAbout the RoleWe are seeking a highly skilled Utilization Management Nurse, Senior to join our team at Blue Shield of California. As a key member of our Utilization Management team, you will play a critical role in ensuring our members receive high-quality, cost-effective care.Key ResponsibilitiesPerform prospective utilization reviews and first-level...
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Medical Director Operations
1 week ago
Rancho Cordova, California, United States Blue Shield of California Full timeJob Title: Medical Director, OperationsBlue Shield of California is seeking a highly skilled Medical Director, Operations to join our team. As a key member of our Medical Management team, you will play a critical role in ensuring that we are on the cutting edge of medical, medication, and payment policy to accelerate the emergence of a value-based healthcare...
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Medical Director Operations
2 days ago
Rancho Cordova, California, United States Blue Shield of California Full timeJob Title: Medical Director, OperationsBlue Shield of California is seeking a highly skilled Medical Director, Operations to join our team. As a key member of our Medical Management team, you will play a critical role in ensuring that our organization remains at the forefront of medical, medication, and payment policy to accelerate the emergence of a...
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Medical Director Operations Lead
3 weeks ago
Rancho Cordova, California, United States Blue Shield of California Full timeJob SummaryWe are seeking a highly skilled Medical Director, Operations Lead to join our team at Blue Shield of California. This is a critical leadership role that requires a strong clinical background, excellent communication skills, and the ability to drive strategic initiatives.Key ResponsibilitiesProvide clinical leadership and oversight to our Medical...
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Senior Utilization Management Nurse
1 month ago
Rancho Cordova, California, United States Blue Shield of California Full timeAbout the RoleThe Utilization Management Nurse, Senior will play a critical role in ensuring the quality and appropriateness of care for our members. As a key member of the Utilization Management team, you will be responsible for reviewing inpatient stays to determine medical necessity and level of care.Key ResponsibilitiesPerform prospective utilization...
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Medical Director Operations
3 weeks ago
Rancho Cordova, California, United States Blue Shield of California Full timeJob Title: Medical Director, OperationsBlue Shield of California is seeking a highly skilled Medical Director, Operations to join our team. As a key member of our Medical Management team, you will play a critical role in ensuring that our organization is at the forefront of medical, medication, and payment policy to accelerate the emergence of a value-based...
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Medical Director Operations
3 weeks ago
Rancho Cordova, California, United States Blue Shield of California Full timeYour RoleThe Medical Director, Operations (Behavioral Health) will be a key member of the Medical Management team at Blue Shield of California. This team is responsible for ensuring that the organization is at the forefront of medical, medication, and payment policy to accelerate the emergence of a value-based healthcare system in California.In this role,...
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Medical Director Operations
2 weeks ago
Rancho Cordova, California, United States Blue Shield Of California Full timeJob SummaryWe are seeking a highly skilled Medical Director Operations to join our team at Blue Shield of California. As a key member of our Medical Management team, you will play a critical role in ensuring that our organization is on the cutting edge of medical, medication, and payment policy to accelerate the emergence of a value-based healthcare system...
