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South Carolina’s largest and oldest health insurance company
Medicare Medical Director
Location
Hawaii + 3 moreAll locations: Hawaii | South Carolina | Utah | Vermont
Posted
121 days ago
Salary
$206.0K - $413.5K / year
Seniority
Lead
Job Description
Medicare Medical Director
BlueCross BlueShield of South Carolina
• 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
Job 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
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