Medicare Medical Director

Palmetto GBA•Columbia, SC

42d•Onsite

About The Position

As member of the senior management team, the Medicare Medical Director provides administrative oversight to the medical staff, analyzes medical review utilization data, researches new medical procedures or technology, and acts as a resource to providers and internal staff on issues concerning medical policies. The Medicare Medical Director will write and revise medical policies. Description Logistics: Palmetto GBA, – one of BlueCross BlueShield's South Carolina subsidiary companies. Location: This position is full-time (40-hours/week) Monday-Friday working ONSITE at our GPC location at 17 Technology Circle, Columbia, SC. You will work an 8-hour shift scheduled during our normal business hours of 8:00AM-5:00PM.

Requirements

Doctorate in a job related field.
5 years post graduate experience in direct patient care.
Microsoft Office
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.

Nice To Haves

Medicare policy knowledge and experience
Experience working as a Cardiologist or Internist
10+ years of post graduate experience in direct patient care

Responsibilities

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.