New

Director Medical Policy Solutions

Blue Cross Blue Shield Association
vision insurance, 401(k)
United States, Illinois, Chicago
Apr 18, 2025
The hiring range for this role is: 125,870.00 - 176,525.00 This is the lowest to highest salary we, in good faith, believe we would pay for this role at the time of this posting. We may ultimately pay more or less than the hiring range and this hiring range may also be modified in the future. A candidate's position within the hiring range may be based on several factors including, but not limited to, specific competencies, relevant education, qualifications, certifications, relevant experience, skills, seniority, performance, shift, travel requirements, and business or organizational needs.This job is also eligible for annual bonus incentive pay. We offer a comprehensive package of benefits including paid time off, 11 holidays, medical/dental/vision insurance, generous 401(k) matching, lifestyle spending account and many other benefits to eligible employees. Note: No amount of pay is considered to be wages or compensation until such amount is earned, vested, and determinable. The amount and availability of any bonus, commission, or any other form of compensation that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law. This role provides medical policy expertise across multiple responsibilities including management of staff of Senior Research Scientists in the evidence review and synthesis process. Participates in cross-collaborative projects, and Blue Plan Medical Policy Group (MPG) engagements regarding development and updating of reference medical policies and topic selection. Builds and maintains effective relationships with BCBS Plan Medical Policy Medical Directors that serve on the MPG. Fosters productive cross-collaboration within Blue Cross Blue Shield Association, the Clinical Informatics Team, and other internal divisions. Primary Job Functions Cultivates and maintains strong relationships with BCBS Plan Medical Policy Director who serve on the MPG. Collaborates effectively with key stakeholders within Office of Clinical Affairs, the Clinical support Team, the Clinical Solutions Team and other BCBSA divisions. Fosters successful cross-collaboration efforts across departments, ensuring seamless communication and alignment of medical policy initiatives. Leads the development and refinement of medical policies, ensuring alignment with industry standards, evidence-based practices, and regulatory requirements and working knowledge of procedural and diagnostic coding. Oversees the day-to-day operations related to medical policy solutions. Manages Senior Research Scientists, coordinating research efforts, and ensuring timely policy updates. Manages the budget allocated for medical policy initiatives, optimizing resources and ensuring cost-effective solutions. Education, Experience and Certification Education Required: Masters Degree Preferred: Clinical background with health plan and clinical policy development experience preferred Licensed RN or PharmD preferred Experience Required: 10 years of progressive healthcare experience developing and aligning operational goals and objectives. This experience should also include conducting research, evaluating evidence review documents, and implementation of strategies to influence organizational behavior or organizational culture. Management experience including managing staff, budget, and leading performance improvements efforts. Preferred: Experience working with academic medical centers, clinical research payers, industry, regulatory agencies, and/or accreditation organizations. Experience working with physician specialty organizations. Knowledge, Skills, and Abilities Skills Strong scientific background and acumen with experience in technology evidence review and synthesis. Requires excellent oral and written communications skills with the capabilities to negotiate, influence, and make effective presentations to varying audiences internal and external to BCBSA. Ability to provide expertise as a thought leader and demonstrate credibility amongst clinical and business leaders across BCBS system. Working knowledge of coding and the role of coding in medical policy. Professional presence for interacting with and influencing key members of leadership. Excellent interpersonal skills for building and fostering key stakeholder relationships. Must be able to represent BCBSA in various forums and with various audiences. The ability to establish credibility and achieve results while balancing various business considerations and priorities is critical. The ability to demonstrate prudent judgment and critical thinking relative to problem analysis at both strategic and tactical levels. Financial Responsibilities Revenue Responsibility: No Budget Responsibility: Yes People Management: Yes #LI-Hybrid