Remote PM&R Medical Director & Policy Leader

BlueCross and BlueShield of South Carolina; New York (NY); Remote; 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

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 senior Medical Director to provide administrative oversight of medical staff and analyze utilization data. The role may involve researching new procedures, writing policies, and guiding providers and staff on medical policies.

The position requires a state medical license, board certification, and strong leadership in a fast-paced environment. Remote or onsite work options are available within the United States.

Qualifications

• Doctorate in a job related field required.
• 5 years post graduate experience in direct patient care.
• Active state medical license and board certification required.

Responsibilities

• Supports operations with case review on medical and regulatory matters.
• Develops claim adjudication criteria for medical judgment scenarios.
• Educates staff and medical community on medical policy and program administration.
• Develops or updates medical policy in consultation with regulatory personnel and consultants.
• Builds relationships with the medical community and liaises with contractors.
• Reviews physician and provider practice patterns and data on unusual utilization.
• Researches new or controversial medical procedures and technology.

Skills

Verbal & written comms

Customer service

Organizational skills

Presentation skills

Judgment & decision-making

Team leadership

Medical utilization review knowledge

Education

Doctorate in medical field

Tools

Microsoft Office

Job description

BlueCross BlueShield of South Carolina is seeking a senior Medical Director to provide administrative oversight of medical staff and analyze utilization data. The role may involve researching new procedures, writing policies, and guiding providers and staff on medical policies.

The position requires a state medical license, board certification, and strong leadership in a fast-paced environment. Remote or onsite work options are available within the United States.