Behavioral Health Medical Director

BlueCross BlueShield of South Carolina

Behavioral Health Medical Director providing clinical oversight for behavioral health activities. Leading strategic and clinical initiatives to align with governmental healthcare standards.

Posted 6/30/2026full-timeColumbia • South Carolina • 🇺🇸 United StatesLead💰 $206,011 - $413,523 per yearWebsite

About the role

Key responsibilities & impact

Provides leadership and medical support on medical and regulatory matters.
Identifies trends in medical and pharmacy costs, utilization trends, and proactively makes recommendations and initiates solutions to impact these.
Provides leadership to clinical team and operations in order to increase compliance, improve efficiency, and increase communication.
Acts as resource for providers, staff, part time medical reviewers, and as requested, customers, on issues concerning medical policies and regulations.
Provides clinical support to Payment Integrity Unit(s) to analyze abuse patterns and recommend solutions.
Provides oversight and leadership with quality improvement and health plan and medical program accreditation(s).
Works with staff and other leadership in developing ideas related to quality initiatives, good clinical support, and outreach to the network.
Responsible for physician review (UM, Appeals, CM) - reviews physician and provider practice pattern analysis and other statistical data.
Conducts research into new or controversial medical procedures and technology.
Educates staff, network providers, and medical community on various aspects of medical policy and program administration.

Requirements

What you’ll need

Doctorate Degree - Medical Doctor (MD) with current active medical license, without restriction.
If Behavioral Health, Medical Director – Doctor of Psychiatry with current active medical license, without restriction.
8 years post graduate experience in direct patient care.
Managed care knowledge and experience required.
Working knowledge of regulatory and accreditation entities, i.e., URAC, NCQA, DOI, and DOL standards.
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, represent our company well.
Ability to work as a team member as well as a leader.
Active, unrestricted medical license from the United States and in the state of hire and current board certification in a recognized specialty.

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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Soft Skills

Excellent Verbal CommunicationExcellent Written CommunicationExcellent Customer ServiceOrganizational SkillsPresentation SkillsGood JudgmentPersuasion SkillsNegotiation SkillsTeam Leadership

Certifications

Current Board Certification