Molecular Diagnostics Medicare Medical Director - Palmetto GBA

BlueCross BlueShield of South Carolina•Washington, NV

6d•$206,011 - $413,523•Hybrid

About The Position

The Molecular Diagnostics Medicare Medical Director at Palmetto GBA oversees medical staff, analyzes utilization data, research emerging molecular technologies, and serves as a resource for providers and internal teams on policy issues. The role also includes developing, writing, and revising medical policies to ensure compliance and support Medicare coverage decisions.

Requirements

Doctorate degree Medical Doctor (MD) with current active license to practice medicine.
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.
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 Suite.

Nice To Haves

Molecular Genetic Pathology fellowship training.
Medicare experience.
Experience interpreting medical evidence.
Scientific training/Research experience with publication history in Molecular Diagnostics.

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.