Remote Physician Advisor, Utilization & Medical Policy

BlueCross and BlueShield of South Carolina; United States; Remote; USD 176,000 - 355,000; Full time

Benefits offered by this job

Subsidized health plans

401k retirement savings plan with 401k

Life Insurance

Paid Time Off (PTO)

On-site cafeterias and fitness centers

Education Assistance

Service Recognition

National discounts

Job summary

BlueCross BlueShield of South Carolina is seeking a Physician Advisor to optimize resource use, assess medical necessity, and support documentation and compliance across care settings. This full-time remote role engages with a multidisciplinary team to ensure appropriate levels of care and adherence to policies.

You will perform utilization management reviews, stay current with CMS/MCG guidelines, and serve as a medical resource for quality improvement.

Qualifications

• MD or DO with current US medical license.
• 8 years of broad clinical experience including utilization and medical review.
• Active board certification in a recognized specialty.
• Proficient in Microsoft Office and documentation practices.

Responsibilities

• Leads UM reviews including pre-admission, continued stay, and post-service reviews.
• Collaborates with physicians and care coordination staff to optimize evidence-based care.
• Responds to clinical review requests in a timely manner.
• Keeps current with CMS and MCG guidelines to support UM decisions.
• Educates providers on medical policies, utilization specs and coding issues.
• Supports quality improvement initiatives and inter-reviewer reliability studies.

Skills

Verbal communication

Written communication

Analytical thinking

Organizational skills

Decision making

Education

MD or DO with current license

Active, unrestricted medical license in the US

Board certification in a recognized specialty

Tools

Microsoft Office

Job description

BlueCross BlueShield of South Carolina is seeking a Physician Advisor to optimize resource use, assess medical necessity, and support documentation and compliance across care settings. This full-time remote role engages with a multidisciplinary team to ensure appropriate levels of care and adherence to policies.

You will perform utilization management reviews, stay current with CMS/MCG guidelines, and serve as a medical resource for quality improvement.