Senior Medical Director

6 hours ago

Reston, Virginia, United States Blue Shield of California Full time
About the Role

We are seeking a highly skilled Senior Medical Director to lead our Behavioral Health team. As a key member of our Medical Management team, you will play a critical role in ensuring that Blue Shield is at the forefront of medical, medication, and payment policy to accelerate the emergence of a value-based healthcare system in California.

Key Responsibilities
  • Lead psychiatric inpatient concurrent review, pre- and post-service utilization review, and collaboration with Nurse Care Managers.
  • Review pre- and post-service behavioral health service requests and render decisions based on member benefits, medical necessity, Blue Shield of California medical policy, FEP medical policy, and legal and regulatory requirements.
  • Engage in telephonic physician-to-physician discussions regarding current members in various levels of care or receiving other specialized services.
  • Train BSC utilization and care management staff, including physicians, psychologists, nurses, social workers, and others as needed.
  • Perform clinical reviews to support utilization management and fraud, waste, and abuse case evaluations.
  • Participate in quality management functions to identify and analyze medical information, develop interventions to improve quality of care and outcomes for members.
  • Participate on projects and committees as necessary.
Requirements
  • A Medical degree (M.D./D.O.) and 12 years' experience, including a minimum of 5 years' behavioral health clinical experience, preferably including hospital experience.
  • Unrestricted California State Medical License required.
  • Board Certification in one of ABMS categories, preferably in Psychiatry through ABPN or AOA.
  • A minimum of 5 years of experience in active clinical behavioral health practice with active recent inpatient psychiatric hospital experience (within the past five years) is desirable.
  • A minimum of 3-5 years of Health Plan experience in Medicare Advantage utilization management, case review, and/or quality improvement activities in a managed care setting is preferred but not required for this position.
  • An ability to work independently to achieve objectives and resolve issues in ambiguous circumstances.
  • Clear, compelling communication skills with demonstrated ability to motivate, guide, influence, and lead others.
  • Strong collaboration skills to effectively work within a team with diverse individuals.
  • An ability to understand overall managed care organization, business strategies, and financial metrics.
  • Well-versed with most areas of behavioral health services and conditions, with ability for rapid, accurate decision-making.
  • Deep knowledge of MHPAEA, SB855, and all regulatory and compliance requirements.
About Blue Shield of California

Blue Shield of California's mission is to ensure all Californians have access to high-quality healthcare at a sustainably affordable price. We are transforming healthcare in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.

We strive to create a diverse, equitable, and inclusive environment where all employees can be their authentic selves and fully contribute to meet the needs of the multifaceted communities we serve.

We are committed to diversity, equity, and inclusion, and we are proud to be a certified Fortune 100 Best Companies to Work, Military Friendly Employer, People Companies that Care, a Leading Disability Employer, and one of California's top companies in volunteering and giving.

We value honesty, humanity, and courage, and we strive to make a positive change across our industry and communities.

  • Senior Medical Director of Pharmacovigilance

    21 hours ago

    Reston, Virginia, United States Discover International Full time

    Senior Medical Director, PharmacovigilanceDiscover International is seeking a seasoned Senior Medical Director to lead our Pharmacovigilance team. As a key member of our CNS organization, you will be responsible for ensuring patient safety across our innovative portfolio of therapies.Key Responsibilities:Develop and implement pharmacovigilance strategies to...

  • Senior Director/Executive Medical Director of Safety and Pharmacovigilance

    7 days ago

    Reston, Virginia, United States Meet Full time

    Meet is seeking a highly experienced and motivated Senior Medical Director/Executive Medical Director to lead our Safety and Pharmacovigilance efforts. As a key member of our team, you will play a crucial role in ensuring the safety and efficacy of our therapeutic products throughout their lifecycle.Position Overview:As the Senior Medical Director/Executive...

  • Senior Medical Director

    2 weeks ago

    Reston, Virginia, United States Biopretium Full time

    Job Title: Senior Medical Director - OncologyLocation: Hybrid work environment with offices in various locations.Reporting Line: Reporting into the Chief Medical OfficerCompany Overview:Biopretium is a biotech company founded in 2014 with headquarters in Washington state. We specialize in developing therapies for oncology indications and have a substantial...

  • Senior Medical Director, Pharmacovigilance Expert

    7 days ago

    Reston, Virginia, United States Discover International Full time

    Job Summary:We are seeking a highly experienced Senior Medical Director to lead our Pharmacovigilance team at Discover International. As a key member of our organization, you will be responsible for ensuring patient safety across our innovative portfolio of therapies.Key Responsibilities:Lead and direct all pharmacovigilance activities, ensuring compliance...

  • Senior Director of Engineering

    4 hours ago

    Reston, Virginia, United States Terumo Medical Corporation Full time

    Job SummaryThe Senior Director of Engineering will lead and manage a team of engineers, overseeing engineering for manufacturing, sustaining, automation, process improvement, operational excellence, and molding and extrusion of high-quality medical devices within the healthcare industry.Key ResponsibilitiesDevelop and implement technical strategies that...

  • Executive Director

    3 hours ago

    Reston, Virginia, United States Sonida Senior Living Full time

    Executive Director OpportunityWe are seeking an experienced Executive Director to lead our assisted living community in providing exceptional resident care and services.About the Role:Lead the community team in delivering high-quality resident care and services.Develop and implement sales and marketing plans to achieve occupancy targets.Manage community...

  • Executive Director

    1 week ago

    Reston, Virginia, United States Sunrise Senior Living Full time

    In the role of General Manager, you are responsible for the day-to-day operations of the community, including full profit and loss responsibility. The General Manager II executes the operations plan and evaluates all aspects of the business, including the recruiting, hiring, development, and performance management of the team. With a focus towards high...

  • Senior Operations Director

    1 week ago

    Reston, Virginia, United States Quadrant Full time

    Job Summary:We are seeking a highly experienced Senior Operations Director to join our team at Quadrant. As a key member of our leadership team, you will be responsible for providing strategic direction and leadership to our program teams, fostering a culture of continuous improvement and accountability.Key Responsibilities:Leadership & Management: Develop...

  • Wellness Nurse LPN

    1 week ago

    Reston, Virginia, United States Sunrise Senior Living Full time

    Job SummarySunrise Senior Living is seeking a skilled and compassionate Wellness Nurse LPN to join our team. As a key member of our care team, you will be responsible for promoting the overall well-being of our residents and ensuring they receive the highest quality care.Key ResponsibilitiesResident Care and Services: Identify ongoing needs and services of...

  • Senior Wellness Nurse

    3 weeks ago

    Reston, Virginia, United States Solera Senior Living Full time

    About Solera Senior Living** Flexible Schedules Required; Weekends Required **Are you passionate about enhancing the lives of seniors? At Solera Senior Living, our Core Values drive our actions and decisions at every level. We seek dedicated individuals who are eager to contribute positively to our community.What Solera Offers: A growing organization that...

  • Senior Wellness Nurse

    3 weeks ago

    Reston, Virginia, United States Solera Senior Living Full time

    About Solera Senior Living** Flexible Schedules Required; Weekends Required **Are you passionate about enhancing the lives of seniors? At Solera Senior Living, our Core Values drive our actions and decisions at every level. We seek dedicated individuals who are eager to contribute positively to our community.What Solera Offers: A growing organization that...

  • Regional Director of Operations

    1 week ago

    Reston, Virginia, United States Tutera Senior Living and Health Care Full time

    Job SummaryWe are seeking a highly skilled and experienced Regional Director of Operations to oversee the operations of our senior living communities in a designated region.Key ResponsibilitiesOversee the day-to-day operations of senior living communities in the assigned regionDevelop and implement business strategies to drive growth and improve operational...

  • Senior Art Director

    6 hours ago

    Reston, Virginia, United States Day One Agency Full time

    Senior Art Director OpportunityWe are seeking a highly skilled Senior Art Director to join our team at Day One Agency. As a key member of our Creative team, you will be responsible for shaping and executing creative ideas, creating client-ready work, and designing assets & presentations that bring our ideas to life visually.The successful candidate will be...

  • Registered Nurse Supervisor

    3 weeks ago

    Reston, Virginia, United States LCS Senior Living Full time

    Position Overview:LCS Senior Living is seeking a dedicated and experienced Registered Nurse Supervisor to oversee our skilled nursing units. This role is essential in ensuring the highest standards of care for our residents.Key Responsibilities:Direct the nursing care provided to residents, adhering to professional standards of practice.Monitor and assess...

  • Regional Director

    17 hours ago

    Reston, Virginia, United States SHOE SHOW, INC. Full time

    Regional Director Opportunity at SHOE SHOW, INC.SHOE SHOW, INC., the country's largest privately held footwear retailer, is seeking an experienced Regional Director to lead our team. This position will be based out of Denver, CO, and local candidates are encouraged to apply.About the RoleAs a Regional Director, you will be responsible for the overall...

  • Senior Capture Manager/Director

    2 days ago

    Reston, Virginia, United States Pontoon Solutions Full time

    {"title": "Senior Capture Manager/Director", "content": "Pontoon Solutions is seeking a seasoned Senior Capture Manager/Director to lead high-value capture opportunities and drive business growth.This role requires a strategic thinker with a proven track record of winning large business development programs in the federal market. The ideal candidate will...

  • Senior Director of Child Development

    14 hours ago

    Reston, Virginia, United States FACES SF Full time

    Job Title: Senior Director of Child DevelopmentFACES SF is seeking a highly experienced and strategic leader to serve as the Senior Director of Child Development. This role will oversee the development and implementation of high-quality, inclusive child development programs for infant, toddler, preschool, and school-aged students at three centers and 34...

  • Senior Director of Customer Experience

    1 week ago

    Reston, Virginia, United States OmniForce Solutions Full time

    About the RoleWe are seeking a seasoned Senior Director of Customer Experience to join our team at OmniForce Solutions. As a key member of our leadership team, you will play a pivotal role in shaping the future of healthcare interactions and driving business success.Key ResponsibilitiesDevelop and execute comprehensive customer experience strategies,...

  • Senior Director of Biostatistics

    13 hours ago

    Reston, Virginia, United States Penfield Search Partners Ltd Full time

    Senior Director of BiostatisticsPenfield Search Partners Ltd is seeking a highly skilled Senior Director of Biostatistics to join our team. As a key member of our organization, you will be responsible for providing statistical input and support for clinical trial design, conduct data analysis, and results interpretation.Key Responsibilities:Provide...

  • Senior Food Services Director

    13 hours ago

    Reston, Virginia, United States PSYNERGY PROGRAMS, INC Full time

    Senior Food Services ManagerAt Psynergy Programs, Inc., we are seeking a highly skilled and experienced Senior Food Services Manager to oversee and train our food service operations within all residential facilities. This is a critical role that requires strong leadership, culinary expertise, and attention to detail.Key Responsibilities:Plan, organize, and...