Medical Director Operations Lead
3 days ago
We 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 Responsibilities- Provide clinical leadership and oversight to our Medical Management department, ensuring high-quality clinical reviews and decision-making.
- Develop and implement clinical initiatives to improve patient outcomes, reduce costs, and enhance the overall quality of care.
- Collaborate with cross-functional teams to identify and address opportunities for process improvement and optimization.
- Lead Concurrent Review and SNF/LTC rounds, as well as Interdisciplinary Care Rounds, to ensure seamless care coordination and management.
- Drive regulatory compliance and ensure adherence to Medi-Cal and Medicare requirements, as well as NCQA guidelines.
- Participate in organization-wide quality improvement efforts and promote a culture of continuous improvement throughout the organization.
- Medical degree (M.D./D.O.) and 12 years' experience, including a minimum of 5 years' experience in active clinical practice in an adult-based primary care specialty (Internal Medicine or Family Practice).
- Unrestricted California State Medical License required.
- Board Certification in one of American Board of Medical Specialties categories, preferably Internal Medicine, required.
- Knowledge of/experience working in a Health Plan setting preferred.
- Knowledge of Medi-Cal, Medicare, California statutes and regulations including DMHC, DHCS preferred.
- Understanding of NCQA accreditation standards preferred.
- Ability to work independently to achieve objectives and resolve issues in ambiguous circumstances.
We offer a competitive salary range of $155,331.00 to $325,743.00 for California, as well as a comprehensive benefits package and opportunities for professional growth and development.
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