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Director, Utilization Management Operations and Strategy

Employer
Blue Cross Blue Shield of Michigan
Location
Detroit, MI
Closing date
Jun 6, 2023

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Profession
Physician
Specialty
Medical Management
Responsible for maintaining operational accountability and strategic direction for the Utilization Management Physician Team, a critical team within the Utilization Management division. Plan, develop, implement, and manage current and new activities related to programs, projects, and processes within the division. Work across the division and organization to drive administrative efficiencies. improve quality and ensure compliance with regulatory requirements.
  • Establish and maintain the strategy and operational activities of the utilization management ecosystem, in partnership with leadership; ensure alignment with broader division and enterprise strategies and initiatives.
  • Develop business cases to support new investment opportunities to advance overall Utilization Management strategy, value, quality, and growth, often in collaboration with related divisional departments.
  • Lead, direct and evaluate the work of physician teammates throughout the department and remove cross-functional barriers; accountable for establishing key departmental and inter-departmental performance indicators and ensuring they are met.
  • Lead and support department medical directors in the implementation of new processes and procedures designed to enhance efficiency and effectiveness, as well as the member and provider experience.
  • Assist in ensuring compliance with legal requirements and regulatory/accrediting agencies' standards and procedures by providing oversight and input into regulatory (e.g., CMS, etc.) and accreditation (e.g., NCQA) reviews related to utilization management and clinical editing programs.
  • Provide day-to-day leadership, coaching and direction for the team, including development of systems and processes for personnel scheduling, identification of cross-training opportunities, and the identification and implementation of other departmental and inter-departmental efficiencies.
  • Develops, prepares, and presents formal presentations, documents and updates across departments, business units and to CMO and executive leadership.
  • Research, compile and analyze appropriate and relevant data and make recommendations for operational improvements.
  • Coordinate the Team's efforts with both internal staff and external vendors with which the team routinely interacts.

QUALIFICATIONS
  • Bachelor's Degree in a related field is required. Master's Degree in a related field is preferred.
  • Seven (7) years of experience in a related field is required.
  • Previous experience leading a team is required. Leadership within the healthcare industry and in working closely with physicians, and other clinicians (e.g., nurses, pharmacists), is strongly preferred.
  • Formal project management and process improvement training and experience preferred.
  • Ability to appropriately manage resources, budgets, issues, and risks for the successful completion of business goals.
  • Excellent oral and written communication, as well as presentation skills.
  • Excellent data analytical skills.
  • Ability to anticipate business needs and implement processes and products that support them.
  • Ability to establish rapport and maintain customer satisfaction without compromising priorities.
  • Ability to interact with and influence stakeholders at all levels of the organization, to build consensus and drive objectives to completion.
  • Ability to lead collaboratively across many teams in a fast paced, growth-oriented environment and matrixed corporate organizational structure.
  • Ability to collaborate and communicate effectively with physician staff and leadership.
Full time

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