BlueCross BlueShield of South Carolina logo
BlueCross BlueShield of South Carolina

South Carolina’s largest and oldest health insurance company

Chief Medical Officer – Medicare Policy

Medical DirectorMedical DirectorFull TimeRemoteLeadTeam 10,001+Since 1946H1B No SponsorCompany SiteLinkedIn

Location

Tennessee

Posted

10 days ago

Salary

0

Seniority

Lead

Postgraduate Degree5 yrs expEnglish

Job Description

Chief Medical Officer – Medicare Policy

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 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

Job Requirements

  • 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

  • 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

Related Categories

Related Job Pages

More Medical Director Jobs

Full TimeRemoteTeam 501-1,000Since 1983H1B No Sponsor

• Perform utilization management case reviews. • Maintain productivity score per company standard. • Maintain annual quality score per company standard. • Complete annual inter-rater reliability testing. • Train across all queues as requested by MRIoA leadership. • Complete all client specific training as requested by MRIoA leadership. • Maintain up-to-date records of case completion if required. • Consistently show willingness to take cases as requested. • Demonstrate respect in interactions across the company. • Consistently submit scheduling requests at least three months in advance. • Consistently work scheduled hours. • Provide ideas for promotion and growth of the company as requested (i.e. contribute to the vision of the company). • Respond appropriately and in a timely manner to licensing/CME requests from the Senior Medical Directors, Vice President of Medical Affairs, or Chief Medical Officer and/or administrative team. • Actively participate in the MRIoA evaluation process (both company and individual). • Participate in all company meetings and committees as requested. • Complete other duties as requested or approved by the CEO and/or chief medical officer. • Thorough understanding of the Company’s clients, products, departments, workflows, and applicable regulatory requirements and accreditation standards

United States
$240K / year

Associate Director, Medical Lead GI

Revolution Medicines

Revolution Medicines (RevMed) is committed to revolutionizing treatment for patients with RAS-addicted cancers, specializing in oncology drug discovery and development. With the mi

Medical Director10 days ago

Role Description We are seeking a highly motivated and experienced professional to join our team as a Medical Lead (ML) for Gastrointestinal and Pancreatic cancers (GI). This role will include: - Developing and executing strategic medical plans including evidence generation, publication, congress activities, and more. - Engaging in peer-to-peer scientific dialogue with healthcare professionals that translate into meaningful insights. - Serving as a therapeutic expert and thought partner to internal teams. - Liaising between Revolution Medicines and clinical study sites/investigators. - Organizing medical education, advisory boards, and medical activities in congresses. Reporting to the Head of Japan Medical Affairs, ML is an essential member of the Medical Affairs team who will work as an extension of the Medical Affairs organization. ML will serve as a key strategic person between Revolution Medicines and healthcare professionals in collaboration with the MSL team. Within the assigned geographic territory, ML will be responsible for cultivating and strengthening professional relationships with key opinion leaders (KOLs), healthcare providers, and academic centers of excellence involved in various phases of product development. The individual will collaborate with stakeholders within medical affairs and across the organization, including but not limited to Clinical Development, Commercial, Program Management, Clinical Operations, and Compliance teams. The ideal candidate is an effective communicator, driven, detail-oriented, proactive, and a skilled collaborator. Qualifications - Minimum 7 years of experience in Medical Affairs or related functions in the pharmaceutical or biotech industry. - Strong understanding of oncology clinical development, evidence generation, treatment landscape, and strategic planning. - Proven ability to analyze and synthesize scientific information effectively. - Experience engaging with healthcare professionals, academic researchers, and medical societies with compliance rules. - Excellent interpersonal, organizational, and presentation skills. - Fluency in Japanese and English (business level). - Ability to work effectively in a matrixed, cross-functional, and multicultural environment. - Experience leading or supporting investigator-initiated or real-world evidence studies. - Willingness to travel up to 20% of time. Requirements - Advanced scientific or medical degrees (MD, RPh, Ns, PhD, MPh, or MS) preferred. - Preferred experience in Gastrointestinal and Pancreatic cancers, and product launch in Japan. - Track record in publication planning, congress presentations, and scientific communications. Benefits - Revolution Medicines takes protection and security of personal data very seriously and respects your right to privacy while using our website and when contacting us by email or phone. - We will only collect, process and use any personal data that you provide to us in accordance with our CCPA Notice and Privacy Policy.

Japan

Senior Medical Director – Rheumatology, Medical Affairs

Sobi - Swedish Orphan Biovitrum AB

Headquartered in Stockholm, Sweden, Swedish Orphan Biovitrum AB is an international biopharmaceutical company dedicated to transforming the lives of individuals

Medical Director10 days ago

• Support the medical business goals and objectives of one of Sobi’s rheumatology products, providing strategic leadership and tactical execution. • Provide strategic and scientific medical affairs leadership for a Rheumatology product in development. • Help develop and implement the US medical strategy, tactical plans, and HCP engagement plans. • Partner with field medical to engage and educate health care providers (HCPs), medical organizations, payers, and patient advocacy groups. • Represent the overall Medical Science organization on cross-functional initiatives as required. • Develop a US evidence generation strategy to address stakeholder (HCPs, payers, and patients) needs. • Oversee any medical affairs-led research initiatives, including US Phase IV clinical programs.

North Carolina
$224K - $290K / year

Senior Medical Director – Rheumatology, Medical Affairs

Sobi - Swedish Orphan Biovitrum AB

Headquartered in Stockholm, Sweden, Swedish Orphan Biovitrum AB is an international biopharmaceutical company dedicated to transforming the lives of individuals

Medical Director10 days ago

• Supports the medical business goals and objectives of one of Sobi’s rheumatology products, providing strategic leadership and tactical execution • Provide strategic and scientific medical affairs leadership for a Rheumatology product in development • Help develop and implement the US medical strategy, tactical plans, and HCP engagement plans • Partner with field medical to engage and educate health care providers (HCPs), medical organizations, payers, and patient advocacy groups • Represent the overall Medical Science organization on cross-functional initiatives as required • Provide feedback and insights to medical affairs deliverables, and cross-functional partners, including the design and implementation of Medical Affairs plans • Develop/enhance KOL and key institution engagement plans, and participate in KOL engagement and development • Help plan and execute advisory boards and educational activities (webinars, medical roundtables, symposium, congress presence) • Collaborate closely with global medical and clinical colleagues, ensuring the US perspective and insights are incorporated into global initiatives

Massachusetts
$224K - $290K / year