BlueCross BlueShield of South Carolina
Health insurance and plan administration
Molecular Diagnostics Medical Director
More 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
Remote within the United States, or onsite in Columbia, South Carolina.
About the job
- A Doctorate degree Medical Doctor (MD) with a current active license to practice medicine is required.
- An active state medical license and current board certification in a recognized specialty are required.
- Five years of postgraduate experience in direct patient care are required.
- Knowledge of medical and utilization review techniques is required.
- Proficiency with the Microsoft Office Suite is required.
- Strong verbal and written communication, customer service, organizational, presentation, spelling, punctuation, and grammar skills are required.
- The ability to persuade, negotiate, or influence others and work effectively as both a team member and leader is required.
- Support operations through case review involving medical and regulatory matters.
- Develop claim adjudication criteria for situations requiring medical judgment.
- 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.
- Develop external relationships with the medical community and serve as liaison between those entities and the contractors.
- Review physician and provider practice-pattern analyses and other statistical data related to unusual medical-service utilization.
- Research new or controversial medical procedures and technologies.
- Oversee medical staff.
- Molecular Genetic Pathology fellowship training.
- Medicare experience.
- Experience interpreting medical evidence.
- Scientific training or research experience with a publication history in Molecular Diagnostics.
About the company
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