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Job Description
Join Blue Shield of California as a Senior Medical Director, leading initiatives in utilization management for Federal Employee Program members. Drive clinical excellence, support strategic goals, and ensure compliance while enhancing the health and wellbeing of members.
Key Responsibilities
Complete clinical reviews within compliance standards
Provide clinical leadership for FEP Medical Director team
Partner with VP Medical Management to develop effective utilization services
Support coordination of care for FEP membership
Serve as a clinical, regulatory, and quality improvement resource
Collaborate on implementation of assigned 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 ABMS category (preferably Internal Medicine)
Minimum of 2 years of medical leadership experience
Minimum 5 years direct patient care experience post residency
Preferred Qualifications
Demonstrated proficiency in MEDICARE/MEDICARE STARS
Experience with NCQA/URAC/Quality Programs
Knowledge of national evidence-based medical necessity criteria