Medical Management Director jobs in Detroit, MI

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)

B
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

D
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

F
Director - Commercial Property Management
  • FRIEDMAN MANAGEMENT COMPANY
  • Farmington, MI OTHER
  • Job Details Level: Management Job Location: Corporate Office - Farmington Hills - Farmington Hills, MI Position Type: Full Time Salary Range: Undisclosed Job Shift: Day Job Category: Management Descri...
  • 27 Days Ago

C
Market Director Case Management
  • Clinical Management Consultants
  • Detroit, MI FULL_TIME
  • An exciting opportunity is available in the greater Detroit area for a Market Director Case Management. This is your chance to become a part of a nationally recognized healthcare system who has been p...
  • 30 Days Ago

F
Director of Case Management - RN License Required
  • Food Management Search
  • Detroit, MI FULL_TIME
  • DIRECTOR CASE MANAGEMENT - Full-time DAYS Direct Hire Competitive Compensation, based on experience. Benefits Package Relocation Assistance Available - Possible Location: Detroit, Michigan. POSITION S...
  • 16 Days Ago

M
Medical Director
  • Mission Veterinary Partners
  • Gibraltar, MI FULL_TIME
  • Overview Gibraltar Veterinary Hospital is hiring!! Our beautiful clinic is seeking a Medical Director Veterinarian. Mission Veterinary Partners (MVP) is seeking an ambitious and team-oriented Veterina...
  • 1 Month Ago

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0 Medical Management Director jobs found in Detroit, MI area

D
Group Director Case Management Days FT
  • Detroit Medical Center Shared Services
  • Detroit, MI
  • The Detroit Medical Center (DMC) is a nationally recognized health care system that serves patients and families through...
  • 4/24/2024 12:00:00 AM

W
Associate Director, Endowment Management
  • Wayne State University
  • Detroit, MI
  • Associate Director, Endowment ManagementWayne State University is searching for an experiencedAssociate Director, Endowm...
  • 4/23/2024 12:00:00 AM

D
Director Case Management FT Days
  • Dmc Receiving Hospital
  • Detroit, MI
  • POSITION SPECIFIC RESPONSIBILITIES: Department Operations Maintains an adequate number and skill mix over seven days a w...
  • 4/23/2024 12:00:00 AM

U
RECEPTIONIST-UPAD Elementary School
  • University Prep Schools
  • Detroit, MI
  • Why U Prep Schools? Do you want a job? Or do you want a career in an organization making the difference in the life of s...
  • 4/23/2024 12:00:00 AM

B
Managing Director
  • Burns & Wilcox
  • Farmington Hills, MI
  • Burns & Wilcox is seeking a dynamic, forward-thinking leader to drive strong and sustainable growth in our Michigan regi...
  • 4/22/2024 12:00:00 AM

H
Director, Product Management - Automotive Division
  • HARMAN International
  • Novi, MI
  • A Career at HARMAN As a technology leader that is rapidly on the move, HARMAN is filled with people who are focused on m...
  • 4/22/2024 12:00:00 AM

E
Childcare Center Director/ Operations Manager
  • Early Start Childcare Llc
  • Detroit, MI
  • Job Description Job Description Benefits/Perks Competitive Compensation Paid Time Off Career Growth Opportunities Job Su...
  • 4/21/2024 12:00:00 AM

R
Sr. Director, Product Management - Coding
  • R1 RCM
  • Detroit, MI
  • Sr. Director, Product Management - Coding The Sr. Director of Product will be responsible for both strategic and tactica...
  • 4/20/2024 12:00:00 AM

Detroit (/dɪˈtrɔɪt/, locally also /ˈdiːtrɔɪt/; French: Détroit, lit. 'strait') is the largest and most populous city in the U.S. state of Michigan, the largest United States city on the United States–Canada border, and the seat of Wayne County. The municipality of Detroit had a 2017 estimated population of 673,104, making it the 23rd-most populous city in the United States. The metropolitan area, known as Metro Detroit, is home to 4.3 million people, making it the second-largest in the Midwest after the Chicago metropolitan area. Regarded as a major cultural center, Detroit is known for its co...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Medical Management Director jobs
$155,005 to $207,578
Detroit, Michigan area prices
were up 1.2% from a year ago

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