Remote PM&R Medical Director & Policy Leader

Palmetto GBA, LLC; Columbia (SC); Hybride; USD 206 000 - 414 000; Plein temps

Avantages offerts par ce poste

Subsidized health plans

401k retirement plan with companymatch

Life Insurance

PTO

Résumé du poste

Palmetto GBA, LLC, a BlueCross BlueShield South Carolina subsidiary, is seeking a Physical Medicine and Rehabilitation Medical Director to provide administrative oversight, analyze medical review data, and guide medical policies. This role requires a medical license, board certification, and leadership in a dynamic health-insurance environment.

The position supports operations with case reviews, policy development, and staff education, and offers remote or onsite work in the United States.

Qualifications

• Doctorate in a related field.
• 5+ years post graduate experience in direct patient care.
• Proficiency with Microsoft Office tools.
• Excellent communication and customer service skills, with strong organizational, presentation, and spelling/grammar abilities.
• Active state medical license and board certification in a recognized specialty.

Responsabilités

• Supports operations through case reviews on medical and regulatory matters.
• Develops claim adjudication criteria requiring medical judgment.
• Provides input on policies, processes, and procedures.
• Educates staff and medical community on medical policy and program administration.
• May develop or update medical policy in consultation with regulatory personnel and consultants.
• Builds external relationships with the medical community and liaises with contractors.
• Reviews physician/provider practice patterns and utilization data.

Connaissances

Excellent verbal and written comms

Excellent customer service

Organizational skills

Presentation skills

Good judgment skills

Spelling and grammar

Persuasion/negotiation

Team leadership

Medical utilization knowledge

Formation

Doctorate in a related field

Outils

Microsoft Office

Description du poste

Palmetto GBA, LLC, a BlueCross BlueShield South Carolina subsidiary, is seeking a Physical Medicine and Rehabilitation Medical Director to provide administrative oversight, analyze medical review data, and guide medical policies. This role requires a medical license, board certification, and leadership in a dynamic health-insurance environment.

The position supports operations with case reviews, policy development, and staff education, and offers remote or onsite work in the United States.