A Day in the Life:

• 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 UMand 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.