Chief Medical Officer, Contractor Medical Director

BlueCross BlueShield of South Carolina • Columbia, SC

1d • 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 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 ideal candidate is interested in fraud, waste, and abuse and has experience in a specialized area of medicine.

This is a full-time, 40-hour-per-week, onsite position with Palmetto GBA, a BlueCross BlueShield of South Carolina subsidiary. The schedule is Monday through Friday, with an eight-hour shift during normal business hours of 8:00 a.m. to 5:00 p.m., at the GPC location at 17 Technology Circle, Columbia, South Carolina. The position 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.
• At least 5 years of postgraduate experience in direct patient care.
• Active state medical license.
• Current board certification in a recognized specialty.
• 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 and as a leader.
• Knowledge of medical and utilization review techniques.
• Ability to obtain a security clearance; applicants must be U.S. citizens.
• Proficiency with Microsoft Office.

Nice To Haves

• Medicare policy knowledge and experience.
• Interest in fraud, waste, and abuse.
• Experience working as a Cardiologist, Rheumatologist, or Internist.
• At least 10 years of postgraduate experience in direct patient care.

Responsibilities

• Provide clinical and administrative oversight to medical staff.
• Support operations through case review on medical and regulatory matters.
• Develop claim adjudication criteria for situations requiring medical judgment.
• Provide input on operational issues, policies, processes, and procedures.
• Educate staff and the medical community on medical policy and program administration.
• Develop and update medical policy in consultation with 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 analyses and statistical data related to unusual medical service utilization.
• Research new or controversial medical procedures and technology.
• Write and revise medical policies.

Benefits

• Subsidized health plans.
• Dental and vision coverage.
• 401(k) 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. Benefits eligibility begins the first of the month following 28 days of employment.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Education Level: Ph.D. or professional degree