Medical Policy Specialist jobs in Detroit, MI

• 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.