Medicare Medical Director

Internal Reference Number: R1048203

Why should you join the Blue Cross Blue Shield of South Carolina family of companies?

Other companies come and go, but we've been part of the national landscape for more than seven decades, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina and much more. We are one of the nation's leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast.

We also have a diverse family of subsidiary companies, allowing us to build on various business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team!

As a member of the senior management team, the Medicare Medical Director provides administrative oversight to the medical staff, analyzes medical review utilization data, researches new medical procedures or technology, and acts as a resource to providers and internal staff on issues concerning medical policies. The Medicare Medical Director will write and revise medical policies.

Palmetto GBA – one of Blue Cross Blue Shield's South Carolina subsidiary companies.

This position is full-time (40-hours/week) Monday-Friday working REMOTE in the US or ONSITE at our GPC location at 17 Technology Circle, Columbia, SC. You will work an 8-hour shift scheduled during our normal business hours of 8:00AM-5:00PM.

• Supports operations in the form of case review on both medical and regulatory matters.
• Develops claim adjudication criteria for situations requiring medical judgment. Provides input on issues and operational policies, processes, and procedures.
• Educates staff and medical community on various aspects of medical policy and program administration.
• May develop and update medical policy in consultation with appropriate regulatory personnel, medical consultants, and professional societies.
• Develops external relationships with the medical community and serves as liaison between these entities and the contractors.
• Reviews physician and provider practice pattern analysis and other statistical data related to unusual medical service utilization.
• Conducts research into new or controversial medical procedures and technology.

• Required
  
  Education:
  
  Doctorate in a job related field.
• Required Experience:
  • 5 years post graduate experience in direct patient care.
• Required Software and tools: Microsoft Office.
• Required
  
  Skills and Abilities:
  
  
  • Excellent verbal and written communication skills.
  • Excellent customer service, organizational, and presentation skills.
  • Good judgment skills. Proficiency in spelling, punctuation, and grammar.
  • Ability to persuade, negotiate, or influence others.
  • Ability to work as a team member as well as a leadership.
  • Knowledge of medical and utilization review techniques.
• Required Licenses and
  
  Certifications:
  
  Active state medical license and current board certification in a recognized specialty.

• Medicare policy knowledge and experience.
• Experience working as a Cardiologist or Internist.
• 10+ years of post graduate experience in direct patient care.

We offer our employees great benefits and rewards. You will be eligible to participate in the benefits the first of the month following 28 days of employment.

• Subsidized health plans, dental and vision coverage.
• 401k retirement savings plan with company match.
• Life Insurance.
• Paid Time Off (PTO).
• On-site cafeterias and fitness centers in major locations.
• Education Assistance.
• Service Recognition.
• National discounts to movies, theaters, zoos, theme parks and more.

We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company.

After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements.

Management will be conducting interviews with those candidates who are the most qualified, with prioritization given to those candidates who demonstrate the required qualifications.

Range Minimum: $

Range Midpoint: $

Range Maximum: $

Please note that this range represents the pay range for this and other positions that fall into this pay grade. Compensation decisions within the range will be dependent upon a variety of factors, including experience, geographic location, and internal equity.

Blue Cross Blue Shield of South Carolina and our subsidiary companies maintain a…