Molecular Diagnostics Medicare Medical Director - Palmetto GBA

033 Palmetto GBA; South Carolina; Hybrid; USD 206.000 - 414.000; Vollzeit

Benefits dieser Stelle

Subsidized health plans

Dental and vision coverage

401k with company match

Life Insurance

PTO

Zusammenfassung

Palmetto GBA, a BlueCross BlueShield of South Carolina subsidiary, seeks a Molecular Diagnostics Medicare Medical Director to oversee medical staff, analyze utilization data, and develop medical policies to support Medicare decisions. Remote in the United States or onsite at Columbia, SC.

The role requires an MD with active license, board certification, 5 years of post-graduate experience, and strong communication and leadership abilities to educate staff and liaise with the medical community.

Qualifikationen

• Doctorate degree: Medical Doctor (MD) with current active license to practice medicine.
• Active state medical license and board certification in a recognized specialty.
• 5 years post graduate experience in direct patient care.
• Excellent verbal and written communication, customer service, organization, and presentation skills.

Aufgaben

• Supports operations with case review on medical and regulatory matters.
• Develops claim adjudication criteria requiring medical judgment.
• Provides input on issues and operational policies, processes, and procedures.
• Educates staff and medical community on medical policy and program administration.
• May develop and update medical policy in consultation with regulatory personnel and medical consultants.
• Develops external relationships with the medical community and liaises with contractors.
• Reviews physician and provider practice pattern analysis and other data on unusual medical service utilization.
• Researches new or controversial medical procedures and technology.

Kenntnisse

Verbal communication

Written communication

Organizational skills

Presentation skills

Persuasion/negotiation

Team leadership

Medical policy knowledge

Ausbildung

MD (Medical Doctor)

Tools

Microsoft Office Suite

Jobbeschreibung

Summary Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but we've been part of the national landscape for more than seven decades, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina … and much more. We are one of the nation's leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies, allowing us to build on various business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team!

Position Purpose

The Molecular Diagnostics Medicare Medical Director at Palmetto GBA oversees medical staff, analyzes utilization data, research emerging molecular technologies, and serves as a resource for providers and internal teams on policy issues. The role also includes developing, writing, and revising medical policies to ensure compliance and support Medicare coverage decisions.

Logistics

Palmetto GBA – one of BlueCross BlueShield's South Carolina subsidiary companies.

Location: This position is full-time (40-hours/week) Monday-Friday working REMOTE in the United States or ONSITE at our GPC location at 17 Technology Circle, Columbia, SC.

Sponsorship: This position is not eligible for sponsorship now or in the future.

What You’ll Do

• 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.
• Educates staff and medical community on various aspects of medical policy and program administration.
• 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.
• Reviews physician and provider practice pattern analysis and other statistical data related to unusual medical service utilization.
• Conducts research into new or controversial medical procedures and technology.

To Qualify For This Position, You’ll Need The Following:

Required Education

Doctorate degree Medical Doctor (MD) with current active license to practice medicine.

Required License and Certificate

Active state medical license and current board certification in a recognized specialty.

Required Work Experience

5 years post graduate experience in direct patient care.

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 Suite.

We Prefer That You Have The Following

• Molecular Genetic Pathology fellowship training.
• Medicare experience.
• Experience interpreting medical evidence.
• Scientific training/Research experience with publication history in Molecular Diagnostics.

Our Comprehensive Benefits Package Includes The Following

• Subsidized health plans
• dental and vision coverage
• 401k retirement savings plan with company match
• Life Insurance
• Paid Time Off (PTO)
• On-site cafeterias and fitness centers in major locations
• Education Assistance
• Service Recognition
• National discounts to movies, theaters, zoos, theme parks and more

What We Can Do for You

We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers, and contribute their unique abilities to the growth of our company.

What to Expect Next

After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements. Management will be conducting interviews with those candidates who are the most qualified, with prioritization given to those candidates who demonstrate the required qualifications.

Pay Range Information

Range Minimum $206,011.00

Range Midpoint $309,767.00

Range Maximum $413,523.00

Pay Transparency Statement

Please note that this range represents the pay range for this and other positions that fall into this pay grade. Compensation decisions within the range will be dependent upon a variety of factors, including experience, geographic location, and internal equity.

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 individuals with disabilities and protected 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 disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company.

If you need special assistance or an accommodation while seeking employment, please email [e-mail] or call 800-288-2227, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.

We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer.

Veterans Welcome

BlueCross is a strong supporter of our veterans, and many service men and women have joined our ranks. We’ve found the dedication, work ethic and job skills that serve well in the military excel in many of our lines of business, and we proudly have veterans filling positions in Human Resources, Information Technology, Customer Service, Operations, General Services and more. Through our government contracts, we also have employees serving at Shaw Air Force Base, the Naval Health Clinic in Charleston, the Naval Hospital in Beaufort and in our hometown of Columbia, S.C., at Ft. Jackson. If you are a full-time employee in the National Guard or Reserves, we will even cover the difference in your pay if you are called to active duty.