- Support the nurse team, facilitate appropriate use of resources, and provide safe and timely decisions.
- The Medical Director will review pre- and post-service requests and render decisions based on the member's benefits, medical necessity, Blue Shield of California medical policy, FEP medical policy, as well as legal and regulatory requirements. The Medical Director must be well-versed with most areas of medicine, show ability for rapid, accurate decision-making, and enjoy care review and the investigation and resolution of complex issues. Experience with CPT coding, medical claims review, hospital billing, and reimbursement is a plus.
- Strong interpersonal and communication skills are needed to effectively interact with other employees and clients in a professional and tactful manner.
- The Medical Director will participate on projects and committees as necessary.
- Problem analysis and clinical decision-making, which are the most critical skills, including the ability to independently formulate and implement solutions.
- An ability to work independently to achieve objectives and resolve issues in ambiguous circumstances.
- An ability to motivate, guide, influence, train, and lead others, including the ability to translate detailed analytic analysis and complex materials into compelling communications.
- An ability to work in high-pressure situations while maintaining good leadership and reasoning ability.
- Strong collaboration skills to effectively work in a team that consist of physicians, nurses, patient care coordinators, and case/disease managers.
- Essential listening, interpreting, negotiating, and consensus building skills to bring business conflicts to successful resolution.
- An ability to understand overall managed care organization, business strategies, and financial metrics.
-
Medical Director, Operations
3 weeks ago
Blue Shield of California Rancho Cordova, United StatesYour Role · The Medical Director provides clinical leadership within the Office of the CMO for Blue Shield Promise Health Plan, which includes management of the physician processes in support of utilization management and transactional functions. These functions include performan ...
-
Medical Director, Operations
2 weeks ago
Blue Shield of California Rancho Cordova, CA, United StatesThe Medical Director, Operations - Federal Employee Program, is a key member of the Medical Management and Operations staff within Health Care Services. This is a front-line utilization management position that has core responsibilities in the areas of inpatient concurrent review ...
-
Medical Director, Operations
4 weeks ago
Blue Shield of California Rancho Cordova, United States ExecutiveYour Role · The Medical Director, Operations - Federal Employee Program, is a key member of the Medical Management and Operations staff within Health Care Services. This is a front-line utilization management position that has core responsibilities in the areas of inpatient conc ...
-
Medical Director, Operations
2 days ago
Blue Shield of California Careers Rancho Cordova, United StatesYour Role · The Medical Director, Operations - Federal Employee Program, is a key member of the Medical Management and Operations staff within Health Care Services. This is a front-line utilization management position that has core responsibilities in the areas of inpatient concu ...
-
Medical Director, Operations
1 week ago
Blue Shield of California San Francisco, United States PermanentYour Role · The Medical Director, Operations - Federal Employee Program, is a key member of the Medical Management and Operations staff within Health Care Services. This is a front-line utilization management position that has core responsibilities in the areas of inpatient conc ...
-
Medical Director, Operations
2 weeks ago
Blue Shield of California Rancho Cordova, United StatesYour Role · The Medical Director provides clinical leadership within the Office of the CMO for Blue Shield Promise Health Plan, which includes management of the physician processes in support of utilization management and transactional functions. These functions include performan ...
-
Medical Director, Operations
22 hours ago
Blue Shield Of California Rancho Cordova, United StatesJob Description · Your Role · The Medical Director, Operations - Federal Employee Program, is a key member of the Medical Management and Operations staff within Health Care Services. This is a front-line utilization management position that has core responsibilities in the area ...
-
Region Director Pharmacy Operations
2 weeks ago
CommonSpirit Health Rancho Cordova, United StatesOverview: · CommonSpirit Health was formed by the alignment of Catholic Health Initiatives (CHI) and Dignity Health. With more than 700 care sites across the U.S. from clinics and hospitals to home-based care and virtual care services CommonSpirit is accessible to nearly one out ...
-
Region Director Pharmacy Operations
1 week ago
CommonSpirit Health Rancho Cordova, United States**Overview**CommonSpirit Health was formed by the alignment of Catholic Health Initiatives (CHI) and Dignity Health. With more than 700 care sites across the U.S. from clinics and hospitals to home-based care and virtual care services CommonSpirit is accessible to nearly one out ...
-
Region Director Pharmacy Operations
1 week ago
CommonSpirit Health Rancho Cordova, United StatesOverview · CommonSpirit Health was formed by the alignment of Catholic Health Initiatives (CHI) and Dignity Health. With more than 700 care sites across the U.S. from clinics and hospitals to home-based care and virtual care services CommonSpirit is accessible to nearly one out o ...
-
Region Director Pharmacy Operations
1 week ago
CommonSpirit Health Rancho Cordova, California, United States PermanentOverview: · CommonSpirit Health was formed by the alignment of Catholic Health Initiatives (CHI) and Dignity Health. With more than 700 care sites across the U.S. from clinics and hospitals to home-based care and virtual care services CommonSpirit is accessible to nearly one out ...
-
Director of Operations
5 days ago
Starwest Botanicals, Inc. Sacramento, United StatesDirector of Operations · Role Summary · Starwest Botanicals is an industry leader in the herb, botanicals, spice, and tea industry. Located in Sacramento, California, Starwest has grown to become a global player in the organic and better-for-you space. With nearly 50 years of exp ...
-
Director of Operations
3 weeks ago
Essel Environmental Sacramento, United StatesEssel Environmental is partnered with an established Civil Engineering and Land Survey Consulting Firm here in Sacramento that is searching for an Operations Director must have the drive and discipline to monitor, maintain and enforce existing department policies and procedures, ...
-
Region Director Pharmacy Operations
3 weeks ago
CommonSpirit Health Rancho Cordova, California, United States PermanentOverview: · CommonSpirit Health was formed by the alignment of Catholic Health Initiatives (CHI) and Dignity Health. With more than 700 care sites across the U.S. from clinics and hospitals to home-based care and virtual care services CommonSpirit is accessible to nearly one out ...
-
Region Director Pharmacy Operations
2 weeks ago
CommonSpirit Health Rancho Cordova, United States**Overview**CommonSpirit Health was formed by the alignment of Catholic Health Initiatives (CHI) and Dignity Health. With more than 700 care sites across the U.S. from clinics and hospitals to home-based care and virtual care services CommonSpirit is accessible to nearly one out ...
-
Director of Operations
3 weeks ago
GrowthWise Search Partners Sacramento, United StatesJob Description · Job DescriptionBring your heart, leadership, strategy and business acumen to a rapidly growing organization in this newly created Director of Operations (Deputy Director) role, with a growth path into Chief Operating Officer. · Make a meaningful difference, bot ...
-
Director of Operations
5 days ago
Unifeye Vision Partners Golden Valley, United StatesDirector of Operations Job - Golden Valley, MN · With five locations throughout the Twin Cities metro area, Northwest Eye is among the largest specialty eye care providers in the Midwest. Our environment is both dynamic and adaptable · SUMMARY · The Director of Operations for N ...
-
Director of Operations
1 week ago
Starwest Botanicals Sacramento, United StatesRole Summary · Starwest Botanicals is an industry leader within the herb, botanicals, spice, and tea industry. Located in Sacramento, California, Starwest has grown to become a global player in the organic and better-for-you space. With nearly 50 years of experience, the company ...
-
Region Director Pharmacy Operations
4 weeks ago
Dignity Health Rancho Cordova, United States**Overview** · CommonSpirit Health was formed by the alignment of Catholic Health Initiatives (CHI) and Dignity Health. With more than 700 care sites across the U.S. from clinics and hospitals to home-based care and virtual care services CommonSpirit is accessible to nearly one o ...
-
Director, Operations
2 weeks ago
Resonetics Sacramento, United States: · The Director, Operations has overall responsibility for all areas of operation including Quality & Manufacturing Engineering, Production & Materials Management. The person in this position leads the development and implementation of organizational strategies, standards and pr ...
Medical Director, Operations - Rancho Cordova, United States - Blue Shield of California
![Default job background](https://contents.bebee.com/public/img/bg-user-ex-1.jpg)
Description
Your Role
The Medical Director, Operations - Federal Employee Program, is a key member of the Medical Management and Operations staff within Health Care Services. This is a front-line utilization management position that has core responsibilities in the areas of inpatient concurrent review, pre and post service utilization review, and collaboration with RN Case and disease managers. This director position will report to the Medical Director of Medical Operations.
Our Blue Shield of California medical directors' function in a critical role to make sure care is appropriate for our members and meets present medical standards. We review member's care before, during, and after it occurs. This includes care in a hospital and medical tests and treatments for a wide variety of clinical scenarios. Care is reviewed for the full spectrum of age groups. We also must stay on the cutting edge of medicine to be able to evaluate all requests. We must base our decisions on sound medical research and well-established national guidelines. These duties will require telephonic physician-to-physician discussions regarding testing, treatment, and hospitalized patients. The Medical Director must feel comfortable in clinical conversations with Blue Shield providers and be a good communicator as well. One must have essential listening, interpreting, negotiating, and consensus-building skills to bring any care conflicts to successful resolution. One also must have strong collaboration skills to effectively work as a team that consist of physicians, nurses, patient care coordinators, and case/disease managers. Teamwork is very important and very satisfying in this role.
Your Work
In this role, you will: