Medical Management Director jobs in Michigan

Medical Management Director directs and oversees the operations and strategic planning of the organization's medical management initiatives and programs. Establishes case management, utilization review, quality and outcome management, and community education programs to provide high quality, cost effective health care services. Being a Medical Management Director develops and implements clinical guidelines for care designed to improve outcomes while managing costs. Requires a bachelor's degree. Additionally, Medical Management Director typically reports to top management. The Medical Management Director typically manages through subordinate managers and professionals in larger groups of moderate complexity. Provides input to strategic decisions that affect the functional area of responsibility. May give input into developing the budget. Capable of resolving escalated issues arising from operations and requiring coordination with other departments. To be a Medical Management Director typically requires 3+ years of managerial experience. (Copyright 2024 Salary.com)

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Medical Director Utilization Management
  • BCBSM Career Section
  • Detroit, MI FULL_TIME
  • Provide clinical expertise across the enterprise for various functions.  Responsible for corporate and medical policy interpretation, recommendation, and review within recognized areas of responsibility.  Advise and collaborate in the development of clinical programs.
     

    Provide clinical support and participate in utilization management, quality management, and care management programs in respective area and identify opportunities for improvement and efficiency.
     
    Assist in the design, development, implementation and assessment of disease state management and health enhancement programs that support the appropriate use of clinical resources in the delivery of consistent high-quality medical care.
     
    Provide clinical leadership for health promotion and education programs and the claims editing department.
     
    Assist in establishing corporate and regional programs to enhance quality of care, reduce medical costs and achieve positive health outcomes.
     
    Serves as clinical resource and subject matter expert to both clinical and non-clinical staff.
     
    Perform clinical reviews and conduct peer to peers.
     
    Conduct discussions with physicians in the BCBSM network regarding: medical policies, utilization management, claims editing, use of resources and quality.
     
    Perform high dollar claims and complex case reviews. 
     
    Participate in inter-rater reliability activities.
     
    Participate in committees and workgroups to achieve department and corporate objectives.
     

    "Qualifications"

    Doctorate from an accredited school of medicine (M.D.) or osteopathy (D.O) required.
     
    Seven (7) years clinical practice experience.
     
    Two (2) years of previous medical director experience working for a health plan, medical group, or hospital in utilization management or medical management preferred.
     
    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 and Health Care Quality & Management is preferred.
     

    Ability to effectively communicate, written and verbally, with external physicians and organizations.   
     

    Proven leadership, problem solving, and the ability to manage multiple priorities.
     
    Results oriented and the ability to take ownership for initiatives and collaborate with cross-functional teams to achieve department and corporate goals.
     
    Demonstrated strong computer literacy and proficient in Microsoft Office Suite and web-based programs.
     
    Understanding of health plan functions related to utilization, care, and quality management as well as HEDIS/STARs and NCQA.  Familiarity with CMS regulations and standards.
     
    Basic knowledge of evidence-based clinical decision support guidelines (InterQual).
     
    Basic knowledge of CPT coding and guidelines.
     
    Other related skills and/or abilities may be required to perform this job.

    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.
     

  • 1 Month Ago

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Group Director Case Management Days FT
  • Detroit Medical Center Shared Services
  • Detroit, MI OTHER
  • The Detroit Medical Center (DMC) is a nationally recognized health care system that serves patients and families throughout Michigan and beyond. A premier healthcare resource, our mission is to help p...
  • 5 Days Ago

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Medical Director
  • Theoria Medical
  • Benton, MI FULL_TIME
  • Position Type: Full-time, exempt Compensation: Up to $400,000 annually monthly Medical Director Stipend Job Location: In person Job Highlights Work-Life Balance: Competitive compensation with balanced...
  • Just Posted

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Medical Director
  • Theoria Medical
  • Niles, MI FULL_TIME
  • Position Type: Full-time, exempt Compensation: Up to $400,000 annually monthly Medical Director Stipend Job Location: In person Job Highlights Work-Life Balance: Competitive compensation with balanced...
  • 1 Day Ago

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Medical Director
  • Theoria Medical
  • Holland, MI FULL_TIME
  • Position Type: Part-time, exempt Compensation: Up to $400,000 annually monthly Medical Director Stipend Job Highlights Work-Life Balance: Competitive compensation with balanced hours. Weekend & On-Cal...
  • 3 Days Ago

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Medical Director
  • Theoria Medical
  • Suttons Bay, MI FULL_TIME
  • Position Type: Part-time, exempt Compensation: Up to $400,000 annually monthly Medical Director Stipend Job Location: In person Job Highlights Work-Life Balance: Competitive compensation with balanced...
  • 7 Days Ago

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Managing Director / Senior Managing Director - Debt Advisory
  • Oberon Securities, LLC
  • New York, NY
  • Oberon Securities, based in New York City, is seeking experienced Managing Directors with expertise raising asset, cash ...
  • 4/24/2024 12:00:00 AM

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Managing Director
  • Transamerica Premier Life Insurance Company
  • Columbia, SC
  • The Managing Director is responsible for growing the business of the District Office by developing new quality sales, co...
  • 4/24/2024 12:00:00 AM

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Risk Management Director - Asset Management
  • Principal Financial Services Inc.
  • Des Moines, IA
  • What You'll DoWere looking for a Risk Management Director to join our Principal Asset Management team. In this role, you...
  • 4/23/2024 12:00:00 AM

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Risk Management Director - Asset Management
  • Principal Financial Group
  • Des Moines, IA
  • What You'll Do: Were looking for a Risk Management Director to join our Principal Asset Management team. In this role, y...
  • 4/22/2024 12:00:00 AM

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Managing Director, Product Management
  • Omnicom Media Group
  • New York, NY
  • Overview Job Description Annalect's 2,000+ innovators leverage data and technology to help clients across Omnicom build ...
  • 4/21/2024 12:00:00 AM

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Managing Director / Senior Managing Director - Debt Advisory
  • Oberon Securities Llc
  • New York, NY
  • Oberon Securities, based in New York City, is seeking experienced Managing Directors with expertise raising asset, cash ...
  • 4/20/2024 12:00:00 AM

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Facilities Management Director
  • Encompass Health
  • Altoona, PA
  • The Facilities Management Director is responsible for ensuring that the company Rehabilitation Hospital, satellite clini...
  • 4/20/2024 12:00:00 AM

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Managing Director
  • NEWMARK
  • Dallas, TX
  • Job Description Newmark (NMRK) is one of the world's leading commercial real estate advisory firms. We provide a fully i...
  • 4/20/2024 12:00:00 AM

Michigan consists of two peninsulas that lie between 82°30' to about 90°30' west longitude, and are separated by the Straits of Mackinac. The 45th parallel north runs through the state—marked by highway signs and the Polar-Equator Trail—along a line including Mission Point Light near Traverse City, the towns of Gaylord and Alpena in the Lower Peninsula and Menominee in the Upper Peninsula. With the exception of two small areas that are drained by the Mississippi River by way of the Wisconsin River in the Upper Peninsula and by way of the Kankakee-Illinois River in the Lower Peninsula, Michigan...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Medical Management Director jobs
$151,776 to $203,254

Medical Management Director in Santa Fe, NM
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Medical Management Director in Port Arthur, TX
Employees who have this job retrieve patient information and data for physicians and medical personnel.
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Medical Management Director in Green Bay, WI
A medical office manager is responsible for the overall operations of a medical practice.
November 30, 2019