Medical Director

• Direct, lead and provide professional oversight for medical management activities related to utilization management, case management, disease management, and quality management activities
• Provide direction, support and medical expertise and oversight to areas within the Health Services Division such including utilization management, quality management, case management, medical claims review, and pharmacy management
• Provide consultative services throughout the corporation
• Communicate with customers regarding their difficult and costly cases
• Seek to improve department/division efficiency through effective use of information system tools
• Review, and implement medical policies and other medical decision-making policies or procedures
• Represent BCBSAZ at professional organizations and acts as liaison with individual health care professionals
• Provide professional oversight for the various clinical peer committees
• Participate in the appeals and grievance processes
• Provide written information to members and providers
• Work to ensure productive relationships with all customers, employers, members, and providers
• Provide leadership to staff and other professionals through clinical excellence, professional behavior and innovative thinking
• Monitor quality performance measures, develop and maintain effective workflows
• Identify opportunities to achieve administrative efficiencies while maintaining service
• Maintain effective working relationships to ensure teamwork in achieving corporate goals
• Contribute to departmental and cross-functional teams to achieve BCBSAZ goals
• Coordinate activities between multiple divisions to achieve desired results
• Perform all other duties as assigned

• 3 years of experience in a clinical setting
• 1 year of experience in physician leadership role, including quality review, utilization review and other managed care functions
• Medical Degree
• Active, current, and unrestricted license to practice medicine in the State of Arizona (a state in the United States)
• Board Certification

3 years of experience in a primary care field