Medical Director, Utilization Management
BSCLong Beach, California, United States • El Dorado Hills, California, United States • Oakland, California, United States • California, United States
Posted February 12, 2026
Full Time
About the Company
Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow – personally, professionally, and financially.
Job Description
The Medical Director will provide clinical leadership, oversee clinical processes, and manage utilization management, care and case management for the Blue Shield Promise Health Plan. They will also serve as a role model and knowledgeable resource in Medi-Cal regulatory requirements and health care quality measurements.
Requirements
- Completion of clinical reviews within standards of care, regulatory, and compliance standards
- Clinical review and resolution of appeals and grievances cases within compliance standards
- Support for process improvement and optimization efforts
- Participation and leadership in cross-functional forums
- Service as a clinical, regulatory, and quality improvement resource and thought leader
- Support for Chief Medical Officer, VP Medical Director, and Senior Medical Director in strategic initiatives
Benefits
- Generous Paid Time Off
- 401k Matching
- Retirement Plan
- Visa Sponsorship
- Four Day Work Week
- Generous Parental Leave
- Tuition Reimbursement
- Relocation Assistance
