Clinical Leadership Director

4 weeks ago


Baltimore, Maryland, United States CareFirst BlueCross BlueShield Full time

Job Summary:

CareFirst BlueCross BlueShield is seeking a highly skilled Clinical Leadership Director to provide strategic leadership of the utilization management team. The successful candidate will be responsible for designing, assessing, implementing, and evaluating utilization management strategies to enhance member engagement, improve access to quality care, and optimize the use of cost-effective health resources.

Key Responsibilities:

  • Provide strategic leadership to the utilization management team
  • Design, assess, implement, and evaluate utilization management strategies
  • Enhance member engagement and improve access to quality care
  • Optimize the use of cost-effective health resources
  • Establish performance metrics to ensure compliance with accreditation standards, CMS requirements, and state, federal, and local laws
  • Plan, direct, and evaluate the full scope of utilization management services offered
  • Work closely with leadership, members, providers, vendors, accounts, and other strategic business partners

Requirements:

  • Bachelor's Degree in Nursing or additional 4 years of relevant work experience
  • 8 years' experience in a clinical and utilization review role
  • 3 years management experience
  • Knowledge of Medicare Advantage, Medicaid Managed Care, and utilization management processes
  • Proficient in standard medical practices and insurance benefit structures
  • Ability to mentor and coach associates to accomplish goals
  • Must be able to meet established deadlines and handle multiple customer service demands

Salary Range: $128,640 - $238,788

Benefits: Comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans

Equal Employment Opportunity: CareFirst BlueCross BlueShield is an Equal Opportunity employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.


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