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Job Description
Join Blue Shield of California as a Senior Medical Director, leading the FEP Utilization Management team. Drive clinical review activities, oversee physician processes, and collaborate on initiatives to enhance healthcare quality for FEP members. This is an impactful role where your leadership will shape the future of medical management.
Key Responsibilities
Complete assigned clinical reviews within compliance standards
Provide clinical leadership and HR oversight for FEP Medical Director team
Develop improved utilization of effective services
Support operational implementation of transformation initiatives
Serve as a clinical, regulatory, and quality improvement resource
Collaborate on strategic initiatives and implementation
Participate in assigned committees and comply with laws and regulations
Required Qualifications
Medical degree (M.D./D.O.)
Completed residency preferably in adult based primary care specialty
Active, unrestricted California State Medical License
Board Certification in one of ABMS categories
Minimum of 2 years of previous medical leadership experience
Minimum 5 years direct patient care experience post residency
Demonstrated proficiency in MEDICARE/MEDICARE STARS, NCQA/URAC/Quality Programs
Knowledge of national evidence-based medical necessity criteria
Ability to work independently and resolve issues
Strong communication skills
Excellent analytical, time management, and organizational skills
Preferred Qualifications
Experience in Internal Medicine, Family Practice, Psychiatry, Geriatrics, OBGYN