Medicare Medical Director
Company: BlueCross BlueShield of South Carolina
Posted on: September 17, 2020
Molecular Genetic Pathology fellowship training.
Director Medical Management Jobs in Michigan. Jobs. Jobs.
Interviews. Blue Cross and Blue Shield of South Carolina3.6?. As
member of the senior management team, 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. May also write and revise medical policies..
Description. *This position can be worked remotely.. *Must be
willing to travel to Columbia, SC at least one week per month for
on-site meetings/training.. •30% 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.. •30% Educates staff and medical community on various
aspects of medical policy and program administration.. •20% 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.. •10% Reviews physician and provider practice pattern
analysis and other statistical data related to unusual medical
service utilization.. •10% Conducts research into new or
controversial medical procedures and technology.. Required
Education:. Doctorate degree Medical Doctor (MD) with current
active license to practice medicine.. Required Work Experience:.
Five years post graduate experience in direct patient care..
Preferred:. Experience interpreting medical evidence.. Scientific
training/Research experience with publication history in Molecular
Diagnostics.. Required Skills and Abilities:. Excellent verbal and
written communication skills.. Excellent customer service,
organizational, and presentation 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 Software :. Microsoft Office.. Required License and
Certificate:. Active state medical license and current board
certification in a recognized specialty.. We participate in
E-Verify and comply with the Pay Transparency Nondiscrimination
Provision. We are an Equal Opportunity Employer.. 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 minorities, females, disabled individuals and
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 physical and mental disabilities.. If you need special
assistance or an accommodation while seeking employment, please
e-mail email@example.com or call 1-800-288-2227, ext. 43172 with
the nature of your request. We will make a determination regarding
your request for reasonable accommodation on a case-by-case basis..
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Keywords: BlueCross BlueShield of South Carolina, Lansing , Medicare Medical Director, Other , Lansing, Michigan
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