Executive Behavioral Health Medical Director - Remote

Blue Cross Blue Shiel; South Carolina; Hybrid; USD 206,000 - 414,000; Full time

Benefits offered by this job

Subsidized health plans

Dental and vision coverage

401k retirement savings with company 2

Life Insurance

Paid Time Off

On-site cafeterias

Education Assistance

Service Recognition

National discounts

Job summary

BlueCross BlueShield of South Carolina seeks a Behavioral Health Medical Director to provide clinical leadership across utilization management, care coordination, quality, and population health for South Carolina Medicaid. The role directs medical policies, guides program strategy, and supports statewide goals for safer transitions of care and reduced ED reliance. Requires an MD license, board cert, and 8+ years of practice.

Qualifications

• MD with current active medical license, without restriction.
• Board certification in a recognized specialty.
• Strong knowledge of managed care and regulatory standards (URAC/NCQA/DOI/DOL).

Responsibilities

• Provide leadership and medical support on medical/regulatory matters.
• Identify trends in medical and pharmacy costs and approve solutions.
• Lead clinical team to improve compliance and efficiency.
• Support quality improvement and accreditation programs.
• Educate staff and network providers on medical policies.
• Oversee physician review and utilization management activities.

Skills

Managed care knowledge

Regulatory knowledge

Communication skills

Leadership

Education

MD (active license)

Board certification in a recognized specialty

Job description

BlueCross BlueShield of South Carolina seeks a Behavioral Health Medical Director to provide clinical leadership across utilization management, care coordination, quality, and population health for South Carolina Medicaid. The role directs medical policies, guides program strategy, and supports statewide goals for safer transitions of care and reduced ED reliance. Requires an MD license, board cert, and 8+ years of practice.