Director, Medical Policy & Clinical Programs

Blue Cross Blue Shield of Michigan; Detroit (MI); On-site; USD 180,000 - 260,000; Full time

Job summary

Blue Cross Blue Shield of Michigan is seeking a senior clinical leader to develop and maintain medical policy, establish rationale for approvals, and provide clinical support across the organization.

The role includes leading clinical reviews, guiding utilization management for prior authorization, and collaborating with cross-functional teams to achieve department and corporate goals. Strong teaching, communication, and leadership skills are essential.

Qualifications

• Doctorate from an accredited school of medicine (M.D.) or osteopathy (D.O.) required.
• Seven (7) years clinical practice experience.
• Current unrestricted state license to practice medicine (MI).
• 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.
• Proven leadership, problem solving, and the ability to manage multiple priorities.
• Strong teaching and communication skills.
• Understanding of health plan functions related to utilization, care, and quality management.

Responsibilities

• Provide clinical program leadership and develop, implement and approve policies within a recognized area of responsibility.
• Provide utilization management for prior authorization procedures and review cases.
• Serve as clinical resource and subject matter expert to clinical and non-clinical staff.
• Assist with clinical research, writing documents, and documenting decisions.
• Participate in JUMP committee meetings.

Skills

Leadership

Communication

Microsoft Office

Problem solving

Cross-functional collaboration

Clinical policy knowledge

Education

Doctorate of Medicine (M.D.) or Doctorate of Osteopathy (D.O.)

Tools

Microsoft Office Suite

Web-based programs

Job description

Blue Cross Blue Shield of Michigan is seeking a senior clinical leader to develop and maintain medical policy, establish rationale for approvals, and provide clinical support across the organization.

The role includes leading clinical reviews, guiding utilization management for prior authorization, and collaborating with cross-functional teams to achieve department and corporate goals. Strong teaching, communication, and leadership skills are essential.