Medicare Medical Director
BlueCross BlueShield of South Carolina
full-time
Posted on:
Location Type: Remote
Location: Hawaii • South Carolina • United States
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Salary
💰 $206,011 - $413,523 per year
Job Level
About the role
- Provides administrative oversight to the medical staff
- Analyzes medical review utilization data
- Researches new medical procedures or technology
- Acts as a resource to providers and internal staff on issues concerning medical policies
- Writes and revises medical policies
- Supports operations in the form of case review on both medical and regulatory matters
- Develops claim adjudication criteria for situations requiring medical judgment
- Provides input on issues and operational policies, processes, and procedures
- Educates staff and medical community on various aspects of medical policy and program administration
- Develops and updates medical policy in consultation with appropriate regulatory personnel, medical consultants, and professional societies
- Develops external relationships with the medical community and serves as liaison between these entities and the contractors
- Reviews physician and provider practice pattern analysis and other statistical data related to unusual medical service utilization
- Conducts research into new or controversial medical procedures and technology
Requirements
- Doctorate in a job related field
- 5 years post graduate experience in direct patient care
- Microsoft Office proficiency
- Excellent verbal and written communication skills
- Excellent customer service, organizational, and presentation skills
- Good judgment skills
- Proficiency in spelling, punctuation, and grammar
- Ability to persuade, negotiate, or influence others
- Ability to work as a team member as well as a leader
- Knowledge of medical and utilization review techniques
- Active state medical license and current board certification in a recognized specialty.
Benefits
- Subsidized health plans, dental and vision coverage
- 401k retirement savings plan with company match
- Life Insurance
- Paid Time Off (PTO)
- On-site cafeterias and fitness centers in major locations
- Education Assistance
- Service Recognition
- National discounts to movies, theaters, zoos, theme parks and more
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
medical review utilization analysisclaim adjudication criteria developmentmedical policy writingcase reviewresearch into medical proceduresutilization review techniques
Soft Skills
verbal communicationwritten communicationcustomer serviceorganizational skillspresentation skillsjudgment skillspersuasionnegotiationteamworkleadership
Certifications
active state medical licenseboard certification in a recognized specialty