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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 care for FEP members. This strategic role involves collaboration with medical leadership to drive initiatives that improve health outcomes and ensure compliance with regulatory standards.
Key Responsibilities
Complete clinical reviews within compliance standards
Provide clinical leadership and HR oversight for FEP Medical Director team
Partner with VP Medical Management and Medical Directors for service utilization
Support coordination of care for FEP membership
Serve as a clinical thought leader within the organization
Collaborate on implementation and operation of initiatives
Participate in assigned Committees
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 of 2 years 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
Strong collaboration skills
Excellent written and verbal communication skills
Preferred Qualifications
Experience with Appeals/Grievances, Case Management/Population Health