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Job Description
Join Blue Shield of California as a Senior Medical Director for FEP Utilization Management, where you'll lead clinical review activities and enhance patient care for Federal Employee Program members. Collaborate with leadership to ensure compliance and drive transformative healthcare initiatives.
Key Responsibilities
Complete assigned clinical reviews within compliance standards
Provide clinical leadership and HR oversight for FEP Medical Director team
Partner with the VP of Medical Management to develop service utilization strategies
Support care coordination for FEP membership
Serve as a clinical and quality improvement resource
Collaborate on transformation initiatives
Required Qualifications
Medical degree (M.D./D.O.)
Completed residency in adult-based primary care specialty
Active, unrestricted California State Medical License
Board Certification in one of ABMS categories
Minimum 2 years of previous medical leadership experience
Minimum 5 years direct patient care experience post residency
Proficiency in MEDICARE/MEDICARE STARS, NCQA/URAC/Quality Programs
Knowledge of national evidence-based medical necessity criteria