Medical Policy Director: Clinical Policy Leader

Blue Cross Blue Shield of Michigan; Detroit (MI); Sur place; USD 200 000 - 300 000; Plein temps

Résumé du poste

Blue Cross Blue Shield of Michigan seeks a physician leader to oversee clinical programs, develop and approve medical policies, and provide expert clinical support across the organization. This role requires strong leadership and documentation of policy decisions, with emphasis on utilization management and cross-functional collaboration.

The candidate will review inquiries, assist with clinical research, and contribute to decisions impacting care quality and policy implementation within the

Qualifications

• MD or DO degree from an accredited school.
• Active MI medical license.
• Board-certified or eligible in an ABMS/ABAO specialty.
• 7+ years of clinical practice experience.
• Strong leadership and communication skills.
• Experience with utilization management and health plan policies.

Responsabilités

• Develop and maintain medical policy and rationale for decisions.
• Provide utilization management for prior authorization procedures.
• Provide clinical support and document decisions across the organization.
• Serve as clinical resource to staff and cross-functional teams.
• Perform clinical reviews and lead peer-to-peer reviews.
• Participate in JUMP committee meetings.

Connaissances

Leadership

Problem solving

Communication skills

Teaching

Cross-functional

Formation

MD/DO

Outils

Microsoft Office

Description du poste

Blue Cross Blue Shield of Michigan seeks a physician leader to oversee clinical programs, develop and approve medical policies, and provide expert clinical support across the organization. This role requires strong leadership and documentation of policy decisions, with emphasis on utilization management and cross-functional collaboration.

The candidate will review inquiries, assist with clinical research, and contribute to decisions impacting care quality and policy implementation within the