Medical Director, Utilization Management - Promise

Job description

Your Role The Healthcare Services team is committed to a single vision of transforming health care delivery for Blue Shield members. Within this framework, the Office of the Promise Chief Medical Officer (CMO) and its Medical Directors report up to the Healthcare Services leadership headed by the Blue Shield of California Chief Medical Officer. The Promise Chief Medical Officer also reports to the CEO and President of Promise Health Plan. This healthcare professional team works collaboratively to improve the quality of patient care and ensure all Californians have equitable access for their health care needs. The Promise Health Plan Medical Director will report to the Promise Health Plan Senior Medical Director, Utilization Management. The Promise Health Plan Medical Director provides clinical leadership within the Blue Shield Promise Health Plan. The Medical Director’s duties include oversight and management of the clinical processes in support of member health initiatives, utilization management, care and case management, and clinically related functions. These functions include performance of pre-service, concurrent and retrospective utilization review, and retrospective provide...