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Chief Medical Officer, Operations
2 months ago
Director of Medical Operations
We are seeking a Director of Medical Operations to become an integral part of our team at Blue Shield of California. As a vital contributor to the Medical Management division, you will oversee the evaluation and decision-making process concerning member and provider requests for a variety of services. This position necessitates a comprehensive understanding of medical and pharmacy regulations, policies, and clinical expertise.
Your Responsibilities:
- Assess and determine the medical necessity of service requests
- Engage with providers and medical leaders to enhance member care
- Offer clinical insights to various departments within the organization
- Process member reviews efficiently while adhering to regulatory standards
- Collaborate with staff to resolve quality-related issues
- Exhibit strong decision-making, organizational, and communication abilities
Your Contributions:
In this role, you will leverage your expertise and experience to make equitable decisions for members. You will collaborate closely with multiple departments and personnel to ensure optimal care for Blue Shield members. Exceptional interpersonal skills and the capacity to work collaboratively with others are crucial for success in this position.
