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The Medical Director will work in Behavioral Health to provide utilization management review, case management review, consultation support, as well as strategic and tactical input on behavioral health initiatives. In addition, the applicant shall provide clinical oversight of staff and serve as a liaison among internal departments, as needed.
A Day in the Life:
Become an effective member of the behavioral health team, which is responsible for improving the holistic health of plan members and ensuring the provision of medically necessary services by:
Performing utilization management reviews according to federal and state guidelines and internal medical policies.
Performing peer reviews related to utilization management cases.
Collaborating with external providers on complex clinical cases to assist with identifying alternative treatment options.
Supervising clinical rounds with Behavioral Health clinical staff to identify appropriate cases to review and to provide ongoing training on clinical issues.
Participating in development of behavioral health and medical policies.
Providing education for internal staff and providers on the needs of populations being served.
Promoting active consultation with clinical staff to avert complications of acute and chronic illness.
Providing clinical input to accreditation team and regulatory compliance as needed.
Performing quality of care reviews and participation in QOC committee as needed.
Providing clinical input to Data/Analytics team in development and implementation of new analytical/reporting tools.
Serving as an ambassador to the community for improving care.
Supporting efforts to foster a collaborative relationship with network providers, including medical groups and individual providers and associated community leaders.
Participating with BCBSMN team members in developing forums and other venues to provide opportunities for education.
Participating with broad BCBSMN team to enhance BH best practices and clinical programs.
Required Skills and Experiences:
7+ years of related professional experience, with 2+ years of health plan payer experience. All relevant experience including work, education, transferable skills, and military experience will be considered.
Ability to thrive in a flat, non-hierarchical environment, achieving goals through collaboration and relationship building versus relying on authority.
Creative, strategic, and innovative thinker, willing to challenge the status quo.
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 clinical 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.
Proven history of reliance upon data and objective evidence to drive decision making versus reliance upon intuition or experience.
Ability to understand metrics at granular levels and in-depth experience with data, health care economics and reporting.
Professional, approachable, and engaging communication/work style that engenders trust, credibility, and collegiality.
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 talent.acquisition@bluecrossmn.com.
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.
