Executive Medical Director & Policy Innovator

033 Palmetto GBA; Columbia (SC); Vor Ort; USD 210.000 - 320.000; Vollzeit

Benefits dieser Stelle

Subsidized health plans

401k retirement savings plan with公司匹配

Life Insurance

Paid Time Off

On-site cafeterias and fitness centers

Education Assistance

Service Recognition

National discounts

Zusammenfassung

Palmetto GBA is seeking a Chief Medical Officer, Contractor Medical Director to provide clinical and administrative oversight of medical staff, analyze utilization data, and guide medical policies. The role requires collaboration with stakeholders, regulators, and internal teams to ensure compliant, evidence-based medical practices.

The position is onsite in Columbia, SC, full-time, Monday–Friday, with security clearance prerequisites and sponsorship not available.

Qualifikationen

• Doctorate in a medical field is required.
• Minimum 5 years post-graduate experience in direct patient care.
• Excellent verbal and written communication skills.
• Strong customer service, organizational and presentation abilities.
• Good judgment; persuasive and influential in negotiations.
• Ability to work as a team member and as a leader.
• Knowledge of medical and utilization review techniques.
• Active state medical license and board certification required.

Aufgaben

• Support operations through case review on 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 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 a liaison between these entities and the contractors.
• Review physician and provider practice pattern analysis and other data related to unusual medical service utilization.
• Conduct research into new or controversial medical procedures and technology.

Kenntnisse

Communication skills

Customer service

Organizational skills

Presentation skills

Judgment

Spelling and grammar

Persuasion/negotiation

Team leadership

Medical/utilization review knowledge

Ausbildung

Doctorate in a medical field

Active state medical license

Board certification in a recognized specialty

Tools

Microsoft Office

Jobbeschreibung

Palmetto GBA is seeking a Chief Medical Officer, Contractor Medical Director to provide clinical and administrative oversight of medical staff, analyze utilization data, and guide medical policies. The role requires collaboration with stakeholders, regulators, and internal teams to ensure compliant, evidence-based medical practices.

The position is onsite in Columbia, SC, full-time, Monday–Friday, with security clearance prerequisites and sponsorship not available.