Senior Medical Policy & Operations Director

Palmetto GBA, LLC; Columbia (SC); On-site; USD 180,000 - 280,000; Full time

Benefits offered by this job

Subsidized health plans

Dental and vision coverage

401k with company match

Life Insurance

PTO

On-site cafeterias

Education Assistance

Service Recognition

National discounts

Job summary

Palmetto GBA, LLC, based in Columbia, South Carolina, seeks a Chief Medical Officer, Contractor Medical Director to provide clinical and administrative oversight of medical staff and to analyze medical review data. The role involves policy development, staff education, and liaison work with the medical community.

Requirements include a Doctorate in a related field, active medical license, board certification, and 5+ years post-graduate patient-care experience.

Qualifications

• Doctorate in a job-related field required.
• Active state medical license and board certification in a recognized specialty.
• Experience in fraud, waste, and abuse is preferred.

Responsibilities

• Provide clinical and administrative oversight to the medical staff.
• Analyze medical review utilization data and research new procedures and technology.
• Develop and update medical policy in consultation with regulatory personnel and professional societies.
• Educate staff and medical community on medical policy and program administration.
• Develop external relationships with the medical community and serve as a liaison.
• Review physician and provider practice patterns and data related to utilization.
• Conduct research into new or controversial medical procedures and technology.

Skills

Verbal communication

Written communication

Customer service

Organizational skills

Presentation skills

Judgment

Persuasion

Team leadership

Utilization review knowledge

Medical policy knowledge

Education

Doctorate (MD/DO)

Active state medical license

Board certification in a recognized specialty

Tools

Microsoft Office

Job description

Palmetto GBA, LLC, based in Columbia, South Carolina, seeks a Chief Medical Officer, Contractor Medical Director to provide clinical and administrative oversight of medical staff and to analyze medical review data. The role involves policy development, staff education, and liaison work with the medical community.

Requirements include a Doctorate in a related field, active medical license, board certification, and 5+ years post-graduate patient-care experience.