Medical Director - Medical Policy (Medicare) at Blue Cross Blue Shield of Michigan in Detroit, Michigan

Job Description:

Responsible for providing leadership and broad strategic direction in the area of Senior Services particularly PPO and HMO Medicare and Medicare Advantage lines of business. Responsible for corporate policy interpretation, recommendation and review within recognized area of responsibility.



Responsible for providing leadership and broad strategic direction for one or more defined medical areas or functions. Responsible for corporate policy interpretation, recommendation and review within recognized area of responsibility.

• Provide high level oversight, leadership and direction for one or more defined medical areas or functions.
• Interpret, recommend and review corporate policy within recognized area of responsibility.
• Refine conceptual framework and provide broad strategic direction.
• Develop and approve strategic and operational plans for assigned units or area of responsibility.
• Impact the performance of BCBSM including short term as well as long term effects on major business units.
• Other duties as assigned.

"Qualifications"

• Doctorate from an accredited school of medicine (M.D.) or osteopathy (D.O.) required.
• Ten (10) year's recent clinical experience in area of specialization plus utilization review experience.
• Current unrestricted state of Michigan doctor of medicine (M.D.) or doctor of osteopathy (D.O.) license.
• Board certified or board eligible and working towards certification in a specialty approved by the American
• Board of Medical Specialists or the American Board of Osteopathy.
• Certification in Utilization Review preferred.
• Knowledge of BCBSM, providers, services and facilities preferred.
• Strong teaching and communication skills.
• Other related skills and/or abilities may be required to perform this job.

Departmental Preferences / Summary:


Five (5) years of experience and in utilization review with strong understanding of CMS regulations not limited to NCD and LCD, Medicare product cycle and benefit design requirements.


All qualified applicants will receive consideration for employment without regard to, among other grounds, race, color, religion, sex, national origin, sexual orientation, age, gender identity, protected veteran status or status as an individual with a disability. Apply Now