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Job Description
Join Blue Shield of California as a Senior Medical Director for FEP Utilization Management, where you will lead clinical review activities, drive compliance, and enhance the healthcare experience for Federal Employee Program members. Collaborate with medical leaders to improve service utilization and support transformative healthcare initiatives.
Key Responsibilities
Complete assigned clinical reviews within compliance standards
Provide clinical leadership for FEP Medical Director team
Develop improved utilization of effective services
Support care coordination for FEP membership
Serve as a clinical thought leader within the organization
Collaborate on strategic initiatives
Abide by departmental policies and compliance standards
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
Proficiency in MEDICARE/MEDICARE STARS and other quality programs
Knowledge of national evidence-based medical necessity criteria