Medicare Contractor Medical Director

Summary
 

Why should you join the BlueCross BlueShield 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!


Position Purpose:

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

Our ideal candidate would bring an interest in fraud, waste, and abuse, as well as have experience in a specialized area of medicine.

Description
 

Logistics: Palmetto GBA - one of BlueCross BlueShield's South Carolina subsidiary companies. 

Location: This position is full-time (40-hours/week) Monday-Friday working 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.  

Government Clearance: This position requires the ability to obtain a security clearance, which requires applicants to be a U.S. Citizen. 

Sponsorship: This position is not eligible for sponsorship now or in the future. 

What You’ll Do: 

• Support operations in the form of case review on both medical and regulatory matters. Develop claim adjudication criteria for situations requiring medical judgment.  

• Provide input on issues and operational policies, processes, and procedures. 

• Educate staff and medical community on various aspects of medical policy and program administration. 

• Develop and update medical policy in consultation with appropriate regulatory personnel, medical consultants, and professional societies.  

• Develop external relationships with the medical community and serve as a liaison between these entities and the contractors. 

• Review physician and provider practice pattern analysis and other statistical data related to unusual medical service utilization. 

• Conduct research into new or controversial medical procedures and technology. 
   

 To Qualify for This Position, You'll Need the Following:  

• 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 leader.  

• Knowledge of medical and utilization review techniques. 

• Required Licenses and Certifications: Active state medical license and current board certification in a recognized specialty. 

We Prefer That You Have the Following:  

• Medicare policy knowledge and experience. 

• Interest in fraud, waste, and abuse. 

• Experience working as a Cardiologist, Rheumatologist, or Internist.  

• 10+ years of post-graduate experience in direct patient care. 

Our Comprehensive Benefits Package Includes The Following: 

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 

What We Can Do for You:  

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. 

What to Expect Next:  

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. 

Equal Employment Opportunity Statement

BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilities and protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations.

We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company.

If you need special assistance or an accommodation while seeking employment, please email[email protected] or call 800-288-2227, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.

We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Here's more information.

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