B

BlueCross BlueShield of South Carolina

Health insurance and plan administration

Physical Medicine and Rehabilitation Medical Director

Full-TimeDeadline 10/31/26
$206k - $413.5k
Expert
PhD
New Mexico, USA+50 moreMore locations: Washington, USA | Kansas, USA | Pennsylvania, USA | North Dakota, USA | Oregon, USA | Delaware, USA | Iowa, USA | California, USA | Washington, DC, USA | Vermont, USA | Wyoming, USA | Connecticut, USA | Texas, USA | Montana, USA | Florida, USA | New Hampshire, USA | Nevada, USA | South Carolina, USA | South Dakota, USA | Georgia, USA | Arizona, USA | Mississippi, USA | Tennessee, USA | Virginia, USA | Arkansas, USA | Minnesota, USA | Colorado, USA | Nebraska, USA | Rhode Island, USA | Utah, USA | Kentucky, USA | West Virginia, USA | New York, NY, USA | Maryland, USA | Hawaii, USA | Wisconsin, USA | Maine, USA | Massachusetts, USA | North Carolina, USA | Oklahoma, USA | Missouri, USA | Ohio, USA | New Jersey, USA | Indiana, USA | Louisiana, USA | Alaska, USA | Michigan, USA | Illinois, USA | Alabama, USA | Idaho, USA
RemoteRemote within the United States, or onsite at the Columbia, South Carolina location.
Medical, Clinical & VeterinaryPhysicians & Surgeons
No H1B Sponsorship
US Citizenship Required

About the job

Requirements
  • A doctorate in a job-related field is required.
  • Five years of postgraduate experience in direct patient care is required.
  • Proficiency with Microsoft Office is required.
  • An active state medical license and current board certification in a recognized specialty are required.
  • Knowledge of medical and utilization review techniques is required.
  • Strong verbal and written communication, customer service, organizational, and presentation skills are required.
  • Good judgment and proficiency in spelling, punctuation, and grammar are required.
  • Ability to persuade, negotiate, or influence others is required.
  • Ability to work as a team member and as a leader is required.
Responsibilities
  • Provide administrative oversight to the medical staff.
  • Support operations by conducting case reviews on medical and regulatory matters.
  • Develop claim adjudication criteria for cases requiring medical judgment and provide input on operational policies, processes, and procedures.
  • Educate staff and the medical community on medical policy and program administration.
  • Develop and update medical policy in consultation with regulatory personnel, medical consultants, and professional societies, as needed.
  • Develop external relationships with the medical community and serve as a liaison between those entities and the contractors.
  • Review physician and provider practice pattern analyses and statistical data concerning unusual medical service utilization.
  • Research new or controversial medical procedures and technology.
Desired Qualifications
  • Experience in the health insurance industry is preferred.
  • Experience in inpatient rehabilitation is preferred.
  • Knowledge of and experience with Medicare policy are preferred.

About the company

B

BlueCross BlueShield of South Carolina

View
Website

BlueCross BlueShield of South Carolina is a South Carolina-owned mutual health insurer and health-plan administrator. It offers individual, employer, Medicare and other coverage while operating provider networks, member services, claims and administrative programs. The organization also supports government and commercial health contracts through related businesses and specialized operations. This profile refers specifically to the South Carolina company, not the national Blue Cross Blue Shield Association, and centers on its role connecting members, employers, healthcare providers and public programs.

Company Size

N/A

Company Stage

N/A

Total Funding

N/A

Headquarters

N/A

Founded

N/A