Remote Medical Director, Molecular Diagnostics & Policy

Palmetto GBA, LLC; Columbia, Northern (SC, KY); Hybrid; USD 206,000 - 414,000; Full time

Benefits offered by this job

Health insurance

401k retirement savings plan

Life Insurance

Paid Time Off (PTO)

On-site cafeterias and fitness centers

Job summary

Palmetto GBA, a BlueCross BlueShield of South Carolina subsidiary, seeks a Molecular Diagnostics Medicare Medical Director. The role oversees medical staff, analyzes utilization data, and guides Medicare coverage decisions. It supports policy development and staff education while maintaining regulatory compliance.

The position offers remote or onsite work in Columbia, SC, with a nationwide scope and a focus on collaboration with medical professionals and regulatory teams.

Qualifications

• Doctorate degree (MD) with current active medical license.
• 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, organizational and presentation skills.
• Proficiency with Microsoft Office Suite.

Responsibilities

• 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 regulatory personnel and medical consultants.
• 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.

Skills

Verbal and written communication

Team leadership

Regulatory knowledge

Medical policy development

Analytical thinking

Education

MD — Medical Doctor

Board certification

Tools

Microsoft Office Suite

Job description

Palmetto GBA, a BlueCross BlueShield of South Carolina subsidiary, seeks a Molecular Diagnostics Medicare Medical Director. The role oversees medical staff, analyzes utilization data, and guides Medicare coverage decisions. It supports policy development and staff education while maintaining regulatory compliance.

The position offers remote or onsite work in Columbia, SC, with a nationwide scope and a focus on collaboration with medical professionals and regulatory teams.