Physical Medicine and Rehabilitation Medical Director

BlueCross BlueShield of South Carolina•Ottawa, VT

7d•$206,011 - $413,523•Remote

About The Position

As member of the senior management team, 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. 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 REMOTE in the United States or 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. What You’ll Do: 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.

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

Provides administrative oversight to the medical staff
Analyzes medical review utilization data
Researches new medical procedures or technology
Acts as a resource to providers and internal staff on issues concerning medical policies
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