- Primary responsibility will be to perform utilization reviews according to federal and state guidelines and internal medical policies.
- Consult with internal medical directors as needed to discuss UM and medical policies for specific diagnoses and conditions emphasizing evidence-based medicine.
- Become an effective member of the medical management team, which is responsible for improving the health of plan members and ensuring the provision of medically necessary services.
- Communicate optimally across multiple functional areas at BCBSMN to promote awareness, alignment and collaboration and ensure organizational objectives are achieved.
- Provide education for internal staff and providers on the needs of populations being served, as needed.
- Promote active consultation to avert complications of acute and chronic illness.
- Provide clinical input to accreditation team and regulatory compliance.
- Quality of care reviews and participation in QOC committee
- Seek to continually improve member satisfaction and health outcomes.
- Serve as an ambassador to the community for improving care, as needed.
- Support efforts to foster a collaborative relationship with network providers, including medical groups and individual providers and associated community leaders.
- Enhance team collaboration and assist in conflict resolution.
- Provide clinical input to Data/Analytics team in development and implementation of new analytical/reporting tools, when requested.
- Participate with BCBSMN team members in developing forums and other venues to provide opportunities for education.
Required Skills and Experiences:
- 7+ years of related professional experience, with 3+ years of health plan payer experience. All relevant experience including work, education, transferable skills, and military experience will be considered.
- Accepting this director level position at BCBSMN requires signing an Employee Confidentiality, Intellectual Property Assignment and Restrictive Covenants Agreement as a condition of employment.
- Able to learn and work in new UM platforms
- Board certification in Psychiatry and several years of clinical and administrative experience are required.
- Unencumbered license to practice medicine in Minnesota (or initiation of application required for start date)
- Ability to establish trust and credibility at all levels of the BCBSMN organization.
- Proficient in leading discussions and public speaking with large and small groups.
- Data driven, process and outcome oriented, and customer focused.
- Professional, approachable, and engaging communication/work style that engenders trust, credibility, and collegiality.
- Proven history of applying data driven reports resulting in actionable solutions.
- Ability to understand metrics at granular levels and in-depth experience with data, health care economics and reporting.
Make A Difference
Blue Cross is an Equal Opportunity and Affirmative Action employer that values diversity. All qualified applicants will receive consideration for employment without regard to, and will not be discriminated against based on race, color, creed, religion, sex, national origin, genetic information, marital status, status with regard to public assistance, disability, age, veteran status, sexual orientation, gender identity, gender expression, or any other legally protected characteristic.
Reasonable Accommodation for Job Seekers with a Disability: If you require reasonable accommodation in completing this application, interviewing, completing any pre-employment testing, or otherwise participating in the employee selection process, please direct your inquiries to
All roles require a high school diploma (or equivalency) and legal authorization to work in the U.S.
Blue Cross and Blue Shield of Minnesota and Blue Plus are nonprofit independent licensees of the Blue Cross and Blue Shield Association. -
Medical Director
1 week ago
Blue Cross and Blue Shield Association Eagan, United StatesAbout Blue Cross · Blue Cross and Blue Shield of Minnesota is one of the most recognized and trusted health care brands in the world with 2.5 million members. We're committed to reinventing health care to improve health for our members and the community. We hope you'll join us. · ...
-
Medical Director
1 week ago
Seymour Comprehensive Treatment Center St Paul, United StatesOverview: · Part-time - Medical Director, Addictions - 6am - 2pm = 24 hours per week · Seymour Comprehensive Treatment Center (CTC) offers outpatient treatment for adults age 18 and older of all genders who are struggling with opioid use disorder. The center, which is located i ...
-
Medical Director
2 weeks ago
Blue Cross and Blue Shield of Minnesota Saint Paul, MN, United StatesAbout Blue Cross Blue Cross and Blue Shield of Minnesota is one of the most recognized and trusted health care brands in the world with 2.5 million members. We're committed to reinventing health care to improve health for our members and the community. We hope you'll join us. H ...
-
medical director
1 week ago
Encore Vet Group Washington, MN, United StatesVeterinarian - Medical Director - CityPaws Animal Hospital - Uptown · Relocation Assistance & Sign-on Bonus Available · Washington, DC · City Paws Animal Hospital - Uptown is looking for a Medical Director to join their growing practice We are looking for a natural leader who is ...
-
Medical Director
5 days ago
UnitedHealth Group Inc. Minneapolis, United States Regular, Full timeOptum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel ...
-
Anesthesiology Medical Director
6 days ago
Fairview Maplewood, United States Full timeM Health Fairview seeks a Medical Director- Fairview Health Medical Group (FHMG) for Anesthesia at M Health Fairview St. John's Hospital. The Medical Director responsibilities will be at a .4 FTE. The clinical portion of the role will be a .6 FTE. · At Fairview, we've always been ...
-
Medical Director
2 weeks ago
UNC Health Eden, United States Full timeDescriptionJoin our One Great Team Become part of an inclusive organization with over 40,000 diverse employees, whose mission is to improve the health and well-being of the unique communities we serve. · Summary: · Are you looking for an opportunity to make a difference in a rura ...
-
Global Medical Director
6 days ago
Boston Scientific Arden Hills, United StatesAdditional Location(s): US-MN-Arden Hills; US-MA-Marlborough; US-MN-Maple Grove · Diversity - Innovation - Caring - Global Collaboration - Winning Spirit - High Performance · At Boston Scientific, we'll give you the opportunity to harness all that's within you by working in teams ...
-
Elevance Health Mendota Heights, United StatesA proud member of the Elevance Health family of companies, Carelon Medical Benefits Management, formerly AIM Specialty Health, is a benefit-management leader in Illinois. Our platform delivers significant cost-of-care savings across an expanding set of clinical domains, including ...
-
Hospice Medical Director
3 weeks ago
AccentCare St. Paul, United States Regular, Full timeOverview · Find Your Passion and Purpose as a Hospice Medical Director · Reimagine Your Career in Hospice · As a medical professional, you know that what you do impacts you as much as your patients and their families, and at AccentCare, we are united in our relentless drive to re ...
-
Fairview Health Services Burnsville, United StatesPractice Description · M Health Fairview seeks a Medical Director- Fairview Health Medical Group (FHMG) for the Obstetrics and Gynecology Specialty Practices. The Medical Director responsibilities will be at a .25 FTE. The clinical portion of the role will be a .75 FTE practicing ...
-
anesthesiology medical director
1 week ago
Fairview Health Services Maplewood, MN, United StatesPractice Description · M Health Fairview seeks a Medical Director- Fairview Health Medical Group (FHMG) for Anesthesia at M Health Fairview St. John's Hospital. The Medical Director responsibilities will be at a .4 FTE. The clinical portion of the role will be a .6 FTE. · At Fair ...
-
Endocrinologist Medical Director
5 days ago
Optum Minneapolis, United StatesThe Medical Director provides physician support to Enterprise Clinical Services operations, the organization responsible for the initial clinical review of service requests for Enterprise Clinical Services. · The Medical Director collaborates with a multidisciplinary team and is ...
-
Associate Medical Director
3 days ago
Herself Health Minneapolis, United StatesAssociate Medical Director - Job Description · Employment Type: Full Time, Exempt · Location: Minneapolis Metro, Minnesota · Compensation: $310,000 annual + total rewards package · Who we are: · At Herself Health, we're on a mission to help women get more life out of life, to ...
-
Associate Medical Director
1 week ago
Herself Health Minneapolis, United StatesAssociate Medical Director - Job Description Employment Type: Full Time, Exempt Location: Minneapolis Metro, Minnesota Compensation: $310,000 annual + total rewards packageWho we are: At Herself Health, we're on a mission to help women get more life out of life, together. We are ...
-
Community Medical Director
2 days ago
Horizon Health Minneapolis, MN, United States Full timeClinic Director - New Outpatient Clinic* · *Horizon Health *is seeking a *Program Director* for our outpatient mental health clinic called Thousand Branches Wellness in *Arden Hills, MN*. This is a *BRAND NEW* clinic opening summer of 2024 and we are looking for someone to join o ...
-
Fairview Health Services Burnsville, MN, United StatesPractice Description · M Health Fairview seeks a Medical Director- Fairview Health Medical Group (FHMG) for the Obstetrics and Gynecology Specialty Practices. The Medical Director responsibilities will be at a .25 FTE. The clinical portion of the role will be a .75 FTE practici ...
-
Fairview Burnsville, MN, United StatesM Health Fairview seeks a Medical Director- Fairview Health Medical Group (FHMG) for the Obstetrics and Gynecology Specialty Practices. The Medical Director responsibilities will be at a .25 FTE. The clinical portion of the role will be a .75 FTE practicing with our M Health Fai ...
-
Global Medical Director
6 days ago
Boston Scientific Corporation Arden Hills, United StatesBoston Scientific is seeking an experienced Cardiac Electrophysiologist looking to transition into the medical device industry. This Global Medical Director (GMD) position for our Rhythm Management Division (with focus on our Cardiac Diagnostic Thera Medical Director, Management, ...
-
Anesthesiology Medical Director
1 week ago
Fairview Maplewood, MN, United StatesM Health Fairview seeks a Medical Director- Fairview Health Medical Group (FHMG) for Anesthesia at M Health Fairview St. John's Hospital. The Medical Director responsibilities will be at a .4 FTE. The clinical portion of the role will be a .6 FTE. · At Fairview, we've always be ...
Medical Director - Eagan, United States - Blue Cross and Blue Shield of Minnesota
Description
About Blue CrossBlue Cross and Blue Shield of Minnesota is one of the most recognized and trusted health care brands in the world with 2.5 million members. We're committed to reinventing health care to improve health for our members and the community. We hope you'll join us.
How Is This Role Important to Our Work?
The Medical Director will work in Medical Management to provide primarily utilization management and case management review for mental health. In addition, applicant shall provide clinical oversight of staff and serve as a liaison among internal departments, as needed.
A Day in the Life: