BlueCross BlueShield of South Carolina
Senior Medical Director (Palmetto GBA)
BlueCross BlueShield of South Carolina, Los Angeles, California, United States
Overview
Internal Reference Number: R1045875
Summary and Description: As a member of the leadership team, you will oversee and direct the synthesis of data and clinical knowledge in the development of information used to inform the detection, correction and prevention of claims payment errors. You will lead a Medical Review team in developing and implementing an efficient and effective medical review strategy, including policy and education integration, to optimize critical medical review cycle times. You will also serve as the Medical Review liaison between internal and external stakeholders.
Logistics Logistics:
Palmetto GBA — one of BlueCross BlueShield's South Carolina subsidiary companies.
Location:
This position is full-time (40 hours/week), Monday–Friday. You will work an 8-hour shift within our normal business hours (8:00 AM–5:00 PM). Travel between buildings may be required. This role is REMOTE in the US or ONSITE at our Government Programs Building at 17 Technology Circle, Columbia, SC, United States.
What You’ll Do
Oversee the development, implementation and communication of Medical Review strategy and the optimization of critical Medical Review cycle times.
Direct and oversee the development of effective Local Coverage Determinations (LCDs) to address identified or prevent potential widespread claims payment errors.
Collaborate with internal stakeholders to address priority areas identified in the Medical Review Strategy.
Assist the VP in engaging external stakeholders to disseminate information and implement process improvements supporting 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 of experience.
Required Skills and Abilities:
Demonstrated effectiveness in creating information that informs strategic and management decisions.
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 an ever-changing business environment and priorities.
Working knowledge of statistical concepts, population statistics and analysis methods.
Excellent communication (verbal and written) skills.
Demonstrated medical systems knowledge/experience.
Ability to exercise good judgment and work with a diverse range of individuals (clinicians, suppliers and all levels of employees).
Ability to work in a dynamic environment with minimal supervision.
Ability to lead as well as work 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 state medical license and current board certification in a recognized specialty.
We Prefer That You Have the Following
Board certified for at least 3 years
Experience working with physician groups, beneficiary organizations, and/or congressional offices is preferred
Prior clinical practice as an attending physician
MBA or business degree
Strong business acumen
Geriatrician or experience with geriatric population
Work experience in health insurance, a utilization review firm, or a health care claims processing organization in a role involving coverage or medical necessity policies and guidelines
Extensive knowledge of the Medicare program, particularly coverage and payment rules
Benefits
Subsidized health plans, dental and vision coverage
401k retirement savings plan with company match
Life Insurance
Paid Time Off (PTO)
On-site cafeterias and fitness centers in major locations
Education Assistance
Service Recognition
National discounts to movies, theaters, zoos, theme parks and more
What We Can Do for You We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company.
What to Expect Next After submitting your application, our recruiting team will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements. Management will interview the most qualified candidates, prioritizing those who demonstrate the required qualifications.
Pay Range Information Range Minimum: 222,723.00
Range Midpoint: 334,548.00
Range Maximum: 446,373.00
Pay Transparency Statement Note that this range represents the pay range for this and other positions that fall into this pay grade. Compensation decisions within the range depend on factors including experience, geographic location, and internal equity.
Equal Employment Opportunity BlueCross BlueShield of South Carolina and our subsidiary companies maintain a nondiscrimination policy and promote employment opportunities 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. As a federal contractor, we maintain affirmative action programs for individuals with disabilities and protected veterans. We provide equal opportunities in all phases of the employment process and comply with applicable laws and regulations.
We are committed to reasonable accommodations for individuals with disabilities, pregnant individuals, and others with pregnancy-related conditions or religious beliefs, provided accommodations do not impose an undue hardship on the company. To request an accommodation, please email mycareer.help@bcbssc.com or call 800-288-2227, ext. 47480. We will determine accommodation on a case-by-case basis.
We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer.
#J-18808-Ljbffr
Summary and Description: As a member of the leadership team, you will oversee and direct the synthesis of data and clinical knowledge in the development of information used to inform the detection, correction and prevention of claims payment errors. You will lead a Medical Review team in developing and implementing an efficient and effective medical review strategy, including policy and education integration, to optimize critical medical review cycle times. You will also serve as the Medical Review liaison between internal and external stakeholders.
Logistics Logistics:
Palmetto GBA — one of BlueCross BlueShield's South Carolina subsidiary companies.
Location:
This position is full-time (40 hours/week), Monday–Friday. You will work an 8-hour shift within our normal business hours (8:00 AM–5:00 PM). Travel between buildings may be required. This role is REMOTE in the US or ONSITE at our Government Programs Building at 17 Technology Circle, Columbia, SC, United States.
What You’ll Do
Oversee the development, implementation and communication of Medical Review strategy and the optimization of critical Medical Review cycle times.
Direct and oversee the development of effective Local Coverage Determinations (LCDs) to address identified or prevent potential widespread claims payment errors.
Collaborate with internal stakeholders to address priority areas identified in the Medical Review Strategy.
Assist the VP in engaging external stakeholders to disseminate information and implement process improvements supporting 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 of experience.
Required Skills and Abilities:
Demonstrated effectiveness in creating information that informs strategic and management decisions.
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 an ever-changing business environment and priorities.
Working knowledge of statistical concepts, population statistics and analysis methods.
Excellent communication (verbal and written) skills.
Demonstrated medical systems knowledge/experience.
Ability to exercise good judgment and work with a diverse range of individuals (clinicians, suppliers and all levels of employees).
Ability to work in a dynamic environment with minimal supervision.
Ability to lead as well as work 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 state medical license and current board certification in a recognized specialty.
We Prefer That You Have the Following
Board certified for at least 3 years
Experience working with physician groups, beneficiary organizations, and/or congressional offices is preferred
Prior clinical practice as an attending physician
MBA or business degree
Strong business acumen
Geriatrician or experience with geriatric population
Work experience in health insurance, a utilization review firm, or a health care claims processing organization in a role involving coverage or medical necessity policies and guidelines
Extensive knowledge of the Medicare program, particularly coverage and payment rules
Benefits
Subsidized health plans, dental and vision coverage
401k retirement savings plan with company match
Life Insurance
Paid Time Off (PTO)
On-site cafeterias and fitness centers in major locations
Education Assistance
Service Recognition
National discounts to movies, theaters, zoos, theme parks and more
What We Can Do for You We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company.
What to Expect Next After submitting your application, our recruiting team will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements. Management will interview the most qualified candidates, prioritizing those who demonstrate the required qualifications.
Pay Range Information Range Minimum: 222,723.00
Range Midpoint: 334,548.00
Range Maximum: 446,373.00
Pay Transparency Statement Note that this range represents the pay range for this and other positions that fall into this pay grade. Compensation decisions within the range depend on factors including experience, geographic location, and internal equity.
Equal Employment Opportunity BlueCross BlueShield of South Carolina and our subsidiary companies maintain a nondiscrimination policy and promote employment opportunities 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. As a federal contractor, we maintain affirmative action programs for individuals with disabilities and protected veterans. We provide equal opportunities in all phases of the employment process and comply with applicable laws and regulations.
We are committed to reasonable accommodations for individuals with disabilities, pregnant individuals, and others with pregnancy-related conditions or religious beliefs, provided accommodations do not impose an undue hardship on the company. To request an accommodation, please email mycareer.help@bcbssc.com or call 800-288-2227, ext. 47480. We will determine accommodation on a case-by-case basis.
We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer.
#J-18808-Ljbffr