Remote Molecular Diagnostics Medical Director (Medicare)

Palmetto GBA; United States; Hybrid; USD 206,000 - 414,000; Full time

Job summary

Palmetto GBA, a BlueCross BlueShield subsidiary, seeks a Molecular Diagnostics Medicare Medical Director to oversee medical staff, analyze utilization data, and research emerging molecular technologies. The role involves developing, writing, and revising medical policies to ensure compliance and support Medicare coverage decisions, with remote or onsite options in Columbia, SC.

Join a national leader in government program administration, offering strong benefits and opportunities to influence

Qualifications

• Doctorate degree MD with 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 in spelling, punctuation, and grammar; ability to persuade or influence others.

Responsibilities

• Supports operations with case review on medical and regulatory matters.
• Develops claim adjudication criteria requiring medical judgment.
• Presents input on policies, processes, and procedures.
• Educates staff and medical community on medical policy and program administration.
• Reviews physician and provider practice pattern analysis and utilization data.
• Conducts research into new or controversial medical procedures and technology.

Skills

Verbal communication

Written communication

Customer service

Organizational skills

Presentation skills

Spelling/grammar

Persuasion/negotiation

Leadership/teamwork

Utilization review knowledge

Education

MD (Doctorate) with active license

Tools

Microsoft Office Suite

Job description

Palmetto GBA, a BlueCross BlueShield subsidiary, seeks a Molecular Diagnostics Medicare Medical Director to oversee medical staff, analyze utilization data, and research emerging molecular technologies. The role involves developing, writing, and revising medical policies to ensure compliance and support Medicare coverage decisions, with remote or onsite options in Columbia, SC.

Join a national leader in government program administration, offering strong benefits and opportunities to influence