Your Role

The Medical Management team ensures that Blue Shield is on the cutting edge of medical, medication, and payment policy to accelerate the emergence of a value-based health care system in California. The Vision Director will report to the Medical Director, Operations. In this role you will provide leadership and guidance on vision program specialty for Blue Shield of California.

The Vision Director provides clinical expertise and consultative support to the organization related to vision. They are responsible for consulting and advising on care management, population health management and all other appropriate areas. Moreover, the Vision Director meaningfully contributes to the Blue Shield priorities and transformative initiatives that continue to improve the health and wellbeing of Blue Shield of California members. You will also provide direction and leadership in compliance with state and federal laws and regulatory requirements related to vision specialty.

*Please note that this is a Part-time role with a flexible, but fixed schedule.

Your Work

In this role, you will:

Provide Clinical oversight of vision specialty program and vision services vendors
Establish a utilization matrix and provide an annual review of vision benefits. Ensure medical and vision integration for utilization management and care management.
Serve as a vision thought leader within the organization and act as subject matter expert and advisor for product strategy, emerging technology trends, public policy, and mandates.
Serve as the primary representative and as an active participant in Compliance Committee, Vendor Partner Quality Committee, Joint Operation Committee meetings, and other meetings or industry-related events as appropriate.
Drive regulatory compliance adherence and leads corrective action efforts with vendors and medical operations teams.
Complete assigned vision services clinical reviews on Appeals and Grievances within compliance standards and provide recommendations based on appeals, grievances, and dispute trend
Attend other meetings or industry related events as appropriate
Attend mandatory Corporate Compliance Program education sessions, as required for this position, including the annual mandatory Standards of Conduct class
Comply with local, state, and federal laws, statutes and regulatory requirements related to vision plan services
Contribute content regarding vision marketing collaterals and draft and author vision articles on behalf of BSC
Any other assigned duties

Your Knowledge and Experience

Doctor of Optometry (OD) degree
Active, unrestricted Optometry license in the state of California required
Maintain Board certification in Optometry through American Board of Optometry (ABO)
Minimum 5 years direct patient care experience post residency
Completed Optometry residency training
5 years’ experience in managed care that can contribute to utilization management, case management, and/or quality improvement activities or other health care administrative operations at the IPA or health plan level
Knowledge of Medicare, California statutes and regulations including DMHC. Understanding of NCQA accreditation standards preferred
An ability to work independently to achieve objectives and resolve issues in ambiguous circumstances
Clear, compelling communication skills with demonstrated ability to motivate, guide, influence, and lead others, including the ability to translate detailed analytic analysis and complex materials into compelling communications
Strong collaboration skills to effectively work within a team that may consist of diverse individuals who bring a variety of different skills ranging from medical to project management and more
Excellent written and verbal communication skills
Excellent analytical, time management and organizational skills
Proficient with computer programs such as Microsoft Excel, Outlook, Word, and PowerPoint