Chief Medical Officer, Contractor Medical Director

BlueCross BlueShield of South Carolina•Columbia, SC

3d•Onsite

About The Position

The Chief Medical Officer, Contractor Medical Director is a member of the senior management team and provides clinical and administrative oversight to the medical staff. The role analyzes medical review utilization data, researches new medical procedures and technology, and serves as a resource to stakeholders, providers, and internal staff on medical policy issues. The position also writes and revises medical policies. The role supports operations through medical and regulatory case review, develops claim adjudication criteria where medical judgment is needed, and contributes to operational policies, processes, and procedures. It educates staff and the medical community on medical policy and program administration, develops medical policy in consultation with regulatory personnel, medical consultants, and professional societies, and builds external relationships with the medical community. The position reviews provider practice patterns and statistical data for unusual medical service utilization and researches new or controversial procedures and technology. This is a full-time, 40-hour-per-week, onsite position at Palmetto GBA's GPC location in Columbia, South Carolina. The schedule is Monday through Friday, with an eight-hour shift scheduled during normal business hours of 8:00 a.m. to 5:00 p.m. The role requires the ability to obtain a security clearance, which requires U.S. citizenship. Sponsorship is not available now or in the future.

Requirements

Doctorate in a job-related field.
Five years of post-graduate experience in direct patient care.
Active state medical license and current board certification in a recognized specialty.
Excellent verbal and written communication skills.
Excellent customer service, organizational, and presentation skills.
Good judgment skills and proficiency in spelling, punctuation, and grammar.
Ability to persuade, negotiate, or influence others.
Ability to work as a team member and as a leader.
Knowledge of medical and utilization review techniques.
Proficiency with Microsoft Office.
Ability to obtain a security clearance; applicants must be U.S. citizens.
Must work onsite in Columbia, South Carolina, Monday through Friday, 40 hours per week, on an eight-hour shift scheduled during normal business hours of 8:00 a.m. to 5:00 p.m.
The position is not eligible for sponsorship now or in the future.

Nice To Haves

Medicare policy knowledge and experience.
Interest in fraud, waste, and abuse.
Experience working as a Cardiologist, Rheumatologist, or Internist.
Ten or more years of post-graduate experience in direct patient care.
Experience in a specialized area of medicine.

Responsibilities

Provide clinical and administrative oversight to the medical staff.
Analyze medical review utilization data.
Support operations through case review involving medical and regulatory matters.
Develop claim adjudication criteria for situations requiring medical judgment.
Provide input on operational policies, processes, and procedures.
Educate staff and the medical community on medical policy and program administration.
Develop and update medical policy in consultation with appropriate regulatory personnel, medical consultants, and professional societies.
Develop external relationships with the medical community and serve as a liaison between those entities and the contractors.
Review physician and provider practice pattern analysis and statistical data related to unusual medical service utilization.
Research new or controversial medical procedures and technology.
Write and revise medical policies.
Serve as a resource to stakeholders, providers, and internal staff on medical policy issues.