Remote PM&R Medical Director & Policy Leader

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

Benefits offered by this job

Health plan coverage

Dental & Vision coverage

401k with company match

Life Insurance

PTO

On-site cafeterias

Education Assistance

Service Recognition

Employee discounts

Job summary

BlueCross BlueShield of South Carolina is seeking a senior Medical Director for Physical Medicine and Rehabilitation. You will provide administrative oversight of medical staff, analyze utilization data, research new procedures, and advise on medical policy across the organization.

The role requires a Doctorate, active medical license, board certification, and at least five years of post-graduate clinical experience. Remote or onsite work options are available within the United States.

Qualifications

• Doctorate in a job related field is required.
• Active state medical license and current board certification are required.
• Excellent verbal and written communication skills are essential.
• Strong customer service, organizational, and presentation abilities are expected.
• Ability to persuade, negotiate, or influence others; capable of team leadership.

Responsibilities

• Supports operations with case review on medical and regulatory matters.
• Develops claim adjudication criteria for medical judgments and input on policies, processes, and procedures.
• Educates staff and medical community on medical policy and program administration.
• May develop and update medical policy with regulators, consultants, and professional societies.
• Develops external relationships with the medical community and serves as liaison to contractors.
• Reviews physician and provider practice patterns; analyzes data on unusual medical service utilization.
• Conducts research into new or controversial medical procedures and technology.

Skills

Verbal communication

Written communication

Customer service

Organization

Presentation skills

Judgment

Persuasion

Team leadership

Medical utilization review

Education

Doctorate

Tools

Microsoft Office

Job description

BlueCross BlueShield of South Carolina is seeking a senior Medical Director for Physical Medicine and Rehabilitation. You will provide administrative oversight of medical staff, analyze utilization data, research new procedures, and advise on medical policy across the organization.

The role requires a Doctorate, active medical license, board certification, and at least five years of post-graduate clinical experience. Remote or onsite work options are available within the United States.