Director Clinical Advisory Services

Blue Cross And Blue Shield Association Washington , DC 20319

Posted 3 months ago


Accountable for collaborating with business teams to provide clinical input related to the design of programs and healthcare benefits. Provides direction for multiple projects, pilots, services and associated deliverables and/or impact related to FEP Benefit Delivery. Serves as the clinical liaison to the Office of Personnel Management (OPM) to discuss various policy/benefit management inquiries.


Responsibilities include but are not limited to:

  • Serves as a clinical consultant in the design, implementation, and interpretation of medical benefits. Works collaboratively and cross-functionally to ensure alignment and operational success.

  • Leads clinical discussions with the Office of Personnel Management (OPM) for benefit negotiations and brochure changes and clarifications.

  • Leads cross-functional projects/teams working with PMO to develop project scope and outcome measures, assuring that operational components are addressed to meet Plan business needs and execution while ensuring projects and pilots are aligned with FEP strategic direction.


Required Basic Qualifications:

  • A Bachelor's degree in a clinical field from an accredited university Minimum of 7 years of healthcare experience Prior experience with a national managed care organization a plus Familiarity with the FEHBP helpful Prior project/team leadership and project management experience Specific in-depth and applied knowledge and understanding of, benefit design and interpretation, , problem resolution, and activity reporting

Preferred Basic Qualifications:

  • Graduate degree Utilization Management Benefit Design

  • Academy of Healthcare Management certification Licensed in a clinical field by the appropriate board

Equal Opportunity Employer

Blue Cross Blue Shield Association is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, sexual orientation, national origin, age, gender identity, disability, veteran status, genetic information or any other legally protected characteristics

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Director Clinical Advisory Services

Blue Cross And Blue Shield Association