Medical Director – Physician Reviewer
MedReview Inc.
Chief Medical Officer - Medicare DME
BlueCross BlueShield of South Carolina
full-time
Posted on:
Location: South Carolina • 🇺🇸 United States
Visit company websiteSalary
💰 $206,011 - $413,523 per year
Job Level
Lead
About the role
- 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.
- May develop and update 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
- Doctoral degree Medical Doctor (MD) with current active license to practice medicine.
- Five years post graduate experience in direct patient care.
- Excellent verbal and written communication skills.
- Excellent customer service, organizational, and presentation 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.
- Microsoft Office Software
