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Job Description
Join Blue Shield of California as a Senior Medical Director where you will lead clinical review activities and enhance utilization management for FEP membership. This role involves collaborating with medical directors to improve healthcare access and ensure compliance with regulatory standards, while driving transformative initiatives.
Key Responsibilities
Complete assigned clinical reviews and ensure compliance standards
Provide clinical leadership and HR oversight for FEP Medical Director team
Partner with VP Medical Management to improve service utilization
Support care coordination for FEP membership
Serve as a clinical and regulatory resource within the organization
Collaborate on the implementation of initiatives
Abide by departmental policies and applicable laws
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 an ABMS category
Minimum of 2 years of previous medical leadership experience
Minimum 5 years of direct patient care experience post-residency
Proficiency in MEDICARE/MEDICARE STARS, NCQA/URAC/Quality Programs
Knowledge of national evidence-based medical necessity criteria
Strong collaboration and communication skills
Excellent analytical, time management, and organizational skills
Preferred Qualifications
Experience in various medical specialties including internal medicine, family practice, psychiatry, geriatrics, OBGYN
Demonstrated ability to work independently
Proficient with Microsoft Excel, Outlook, Word, and PowerPoint