Medical Director, Utilization Management - Commercial Prior Authorization Review

The Medical Management team ensures that Blue Shield of California (BSC) is on the cutting edge of utilization management reimagined to accelerate the development and sustainability of a value-based health care system in California. The Medical Director, Utilization Management – Commercial Prior Authorization Review will report to the Senior Medical Director, Utilization Management. In this role, you will deliver and collaborate on clinical review activities, which includes management of the physician processes in support of utilization management and transactional functions for BSC Commercial and Medicare members. These functions include performance of pre-service and retrospective utilization review, and operationalization of joint initiatives supporting BSC strategic goals.