Remote Medical Director – Molecular Diagnostics

Southcarolinablues; Columbia, Northern (SC, KY); Hybride; USD 206 000 - 414 000; Plein temps

Avantages offerts par ce poste

Subsidized health plans

Dental coverage

Vision coverage

401k with company match

Life Insurance

PTO

On-site cafeterias

Education assistance

Service recognition

Résumé du poste

BlueCross BlueShield of South Carolina is seeking a Molecular Diagnostics Medicare Medical Director to oversee medical staff, analyze utilization data, and develop medical policies for Medicare coverage decisions. This full-time role supports providers and internal teams across the nation, with option for remote work or onsite at Columbia, SC.

The position requires an MD with an active license, board certification, and 5 years of post-graduate patient care experience.

Qualifications

• MD with active state medical license.
• Board certification in a recognized specialty.
• 5 years post graduate experience in direct patient care.
• Proficiency in medical policy and utilization review techniques.

Responsabilités

• Supports operations with case review on medical and regulatory matters.
• Develops claim adjudication criteria requiring medical judgment.
• Provides input on medical policy, procedures, and operations.
• Educates staff and medical community on medical policy and program administration.
• Collaborates with regulatory personnel and consultants to update medical policies.
• Develops external relationships with the medical community and contractors.
• Reviews physician practice patterns and related analytics.
• Researches new or controversial procedures and technologies.

Connaissances

Excellent communication

Customer service

Organizational skills

Presentation skills

Persuasion

Team leadership

Utilization review knowledge

Formation

MD degree

Outils

Microsoft Office Suite

Description du poste

BlueCross BlueShield of South Carolina is seeking a Molecular Diagnostics Medicare Medical Director to oversee medical staff, analyze utilization data, and develop medical policies for Medicare coverage decisions. This full-time role supports providers and internal teams across the nation, with option for remote work or onsite at Columbia, SC.

The position requires an MD with an active license, board certification, and 5 years of post-graduate patient care experience.