Physical Medicine and Rehabilitation Medical Director

BlueCross BlueShield of South Carolina•W@H South Carolina, VT

18h•$206,011 - $413,523•Hybrid

About The Position

As a member of the senior management team, the Physical Medicine and Rehabilitation 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. May also write and revise medical policies.

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

Health insurance industry experience
Experience in INPATIENT Rehabilitation
Medicare policy knowledge and experience

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.