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Medical Director
2 months ago
We are seeking a highly experienced Medical Director to lead our Utilization Management and Quality Management programs. As a key member of our leadership team, you will be responsible for providing clinical expertise and guidance to support the development and implementation of our medical policies and programs.
Key Responsibilities- Provide clinical support and participate in utilization management, quality management, and care management programs to identify opportunities for improvement and efficiency.
- Assist in the design, development, implementation, and assessment of disease state management and health enhancement programs to support the appropriate use of clinical resources.
- Provide clinical leadership for health promotion and education programs and the claims editing department.
- Assist in establishing corporate and regional programs to enhance quality of care, reduce medical costs, and achieve positive health outcomes.
- Serve as a clinical resource and subject matter expert to both clinical and non-clinical staff.
- Perform clinical reviews and conduct peer-to-peer discussions with physicians in the BCBSM network.
- Participate in inter-rater reliability activities and committees to achieve department and corporate objectives.
- Doctorate from an accredited school of medicine (M.D.) or osteopathy (D.O.) required.
- Seven (7) years of clinical practice experience.
- Two (2) years of previous medical director experience working for a health plan, medical group, or hospital in utilization management or medical management preferred.
- Current unrestricted state of Michigan Doctor of Medicine (M.D.) or doctor of osteopathy (D.O.) license.
- 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.
- Certification in Utilization Review and Health Care Quality & Management is preferred.
- Three (3) years of post-residency patient care experience, preferably in an inpatient or post-acute setting.
- Basic knowledge of evidence-based clinical decision support guidelines (InterQual).
- Basic knowledge of CPT coding and guidelines.
