Utah Staffing
Job Title
As a member of the leadership team, you will oversee and direct the synthesis of data and clinical knowledge in the development of information that is used to inform the detection, correction and prevention of claims payment errors. You will lead a Medical Review team in the development and implementation of an efficient and effective medical review strategy which includes the integration of policy and education, that optimizes critical medical review cycle times. In this role you will also serve as the Medical Review liaison between internal and external stakeholders. Location: This position is full-time (40-hours/week) Monday-Friday. You will work an 8-hour shift scheduled during our normal business hours of 8:00AM-5:00PM. You may be required to travel between buildings. This role is REMOTE in the US or ONSITE at our Government Programs Building at 17 Technology Circle, Columbia, SC in the United States. What You'll Do: Oversees the development, implementation and communication of Medical Review strategy and the optimization of critical Medical Review cycle times. Directs and oversees the development of effective Local Coverage Determinations (LCDs) aimed at addressing identified or preventing potential widespread claims payment errors. Collaborates with internal stakeholders to address priority areas identified in the Medical Review Strategy. Assists the VP to engage external stakeholders in the efforts to disseminate information and implement process improvements in support of the Medical Review Strategy. To Qualify for This Position, You'll Need the Following: Required Education: Doctorate in a job related field. Required Experience: 10 years experience. Required Skills and Abilities: Demonstrated effectiveness in the creation of information that successfully informs strategic and management decisions. Demonstrated knowledge/experience in directing and participating in the development of medical coverage policy. Strong analytical, judgment, presentation, critical thinking, organizational and planning skills. Ability to adapt to ever changing business environment/priorities. Working knowledge of statistical concepts, population statistical and analysis methods. Excellent communication (verbal and written) skills. Demonstrated medical systems knowledge/experience. Ability to exercise good judgment with capacity of working/communicating with diverse range of individuals (clinicians, suppliers and all levels of employees). Ability to work in a very dynamic environment with minimal supervision. Ability to work as a leader as well as a team member. Knowledge of medical and utilization review techniques. Ability to comprehend government regulatory and political structures. Required Software: Microsoft Office Software Required License and Certificate: If Medical Doctor (MD) or Doctor of Osteopathy (DO), active... BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains Affirmative Action programs to promote employment opportunities for minorities, females, disabled individuals and veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws nd regulations.
As a member of the leadership team, you will oversee and direct the synthesis of data and clinical knowledge in the development of information that is used to inform the detection, correction and prevention of claims payment errors. You will lead a Medical Review team in the development and implementation of an efficient and effective medical review strategy which includes the integration of policy and education, that optimizes critical medical review cycle times. In this role you will also serve as the Medical Review liaison between internal and external stakeholders. Location: This position is full-time (40-hours/week) Monday-Friday. You will work an 8-hour shift scheduled during our normal business hours of 8:00AM-5:00PM. You may be required to travel between buildings. This role is REMOTE in the US or ONSITE at our Government Programs Building at 17 Technology Circle, Columbia, SC in the United States. What You'll Do: Oversees the development, implementation and communication of Medical Review strategy and the optimization of critical Medical Review cycle times. Directs and oversees the development of effective Local Coverage Determinations (LCDs) aimed at addressing identified or preventing potential widespread claims payment errors. Collaborates with internal stakeholders to address priority areas identified in the Medical Review Strategy. Assists the VP to engage external stakeholders in the efforts to disseminate information and implement process improvements in support of the Medical Review Strategy. To Qualify for This Position, You'll Need the Following: Required Education: Doctorate in a job related field. Required Experience: 10 years experience. Required Skills and Abilities: Demonstrated effectiveness in the creation of information that successfully informs strategic and management decisions. Demonstrated knowledge/experience in directing and participating in the development of medical coverage policy. Strong analytical, judgment, presentation, critical thinking, organizational and planning skills. Ability to adapt to ever changing business environment/priorities. Working knowledge of statistical concepts, population statistical and analysis methods. Excellent communication (verbal and written) skills. Demonstrated medical systems knowledge/experience. Ability to exercise good judgment with capacity of working/communicating with diverse range of individuals (clinicians, suppliers and all levels of employees). Ability to work in a very dynamic environment with minimal supervision. Ability to work as a leader as well as a team member. Knowledge of medical and utilization review techniques. Ability to comprehend government regulatory and political structures. Required Software: Microsoft Office Software Required License and Certificate: If Medical Doctor (MD) or Doctor of Osteopathy (DO), active... BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains Affirmative Action programs to promote employment opportunities for minorities, females, disabled individuals and veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws nd regulations.