Remote Medical Director, Molecular Diagnostics Policy

033 Palmetto GBA; South Carolina; Hybrid; USD 206,000 - 414,000; Full time

Benefits offered by this job

Subsidized health plans

Dental and vision coverage

401k with company match

Life Insurance

PTO

Job summary

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.

Qualifications

• 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.

Responsibilities

• 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.

Skills

Verbal communication

Written communication

Organizational skills

Presentation skills

Persuasion/negotiation

Team leadership

Medical policy knowledge

Education

MD (Medical Doctor)

Tools

Microsoft Office Suite

Job description

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.