Chief Medical Officer – Medicare Policy

BlueCross BlueShield of South Carolina

Chief Medical Officer at BlueCross BlueShield of South Carolina overseeing medical policy generation and provider relations. Responsibilities include data analysis and administrative oversight of the medical staff.

Posted 6/11/2026full-timeRemote • Tennessee • 🇺🇸 United StatesLeadWebsite

About the role

Key responsibilities & impact

Provides administrative oversight to the medical staff
Analyzes medical review utilization data
Researches new medical procedures or technology
Acts as a lead resource to providers and internal staff on issues concerning medical policies
Heavily involved in policy generation, includes the development of new policy and revision of old policy
Supports operations in the form of case review on both medical and regulatory matters
Develops claim adjudication criteria for situations requiring medical judgment
Educates staff and medical community on various aspects of medical policy and program administration
Develops and updates medical policy in consultation with 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

What you’ll need

Doctorate in a job-related field
Active state medical license and current board certification in a recognized specialty
5 years post graduate experience in direct patient care
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
Microsoft Office proficiency

Benefits

Comp & perks

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

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

medical review utilization analysispolicy generationclaim adjudication criteria developmentmedical judgmentmedical policy developmentresearch into medical proceduresstatistical data analysis

Soft Skills

verbal communicationwritten communicationcustomer serviceorganizational skillspresentation skillsjudgment skillspersuasionnegotiationteamworkleadership

Certifications

Doctorate in a job-related fieldactive state medical licensecurrent board certification in a recognized specialty