BlueCross BlueShield of South Carolina
Senior Medical Director (Palmetto GBA)
BlueCross BlueShield of South Carolina, Billings Metropolitan Area, Montana, United States
Overview
Summary Position Purpose: 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 informs 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 & Logistics
Logistics:
Palmetto GBA — one of BlueCross BlueShield of South Carolina\u2019s subsidiary companies. 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 8:00 AM–5:00 PM. 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, United States.
What You\u2019ll 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.
Qualifications
To Qualify for This Position, You\u2019ll 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 statistics 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.
Preferred Qualifications
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 the health insurance industry, a utilization review firm, or another health care claims processing organization in a role that involved developing coverage or medical necessity policies and guidelines. Extensive knowledge of the Medicare program, particularly the 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 members 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 be conducting interviews with those candidates who are the most qualified, with prioritization given to those candidates who demonstrate the required qualifications.
Pay Range Information
Pay Range:
Range Minimum $222,723.00; Range Midpoint $334,548.00; Range Maximum $446,373.00 Pay Transparency Statement:
This range represents the pay for this and other positions in the same pay grade. Compensation decisions depend on experience, geographic location, and internal equity.
Equal Employment Opportunity
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. 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 and regulations. We are committed to providing reasonable accommodations to individuals with disabilities and others as required by law. If you need special assistance or an accommodation during seeking employment, please email mycareer.help@bcbssc.com or call 800-288-2227, ext. 47480. We participate in E-Verify and comply with Pay Transparency nondiscrimination requirements. We are an Equal Opportunity Employer.
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Summary Position Purpose: 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 informs 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 & Logistics
Logistics:
Palmetto GBA — one of BlueCross BlueShield of South Carolina\u2019s subsidiary companies. 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 8:00 AM–5:00 PM. 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, United States.
What You\u2019ll 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.
Qualifications
To Qualify for This Position, You\u2019ll 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 statistics 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.
Preferred Qualifications
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 the health insurance industry, a utilization review firm, or another health care claims processing organization in a role that involved developing coverage or medical necessity policies and guidelines. Extensive knowledge of the Medicare program, particularly the 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 members 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 be conducting interviews with those candidates who are the most qualified, with prioritization given to those candidates who demonstrate the required qualifications.
Pay Range Information
Pay Range:
Range Minimum $222,723.00; Range Midpoint $334,548.00; Range Maximum $446,373.00 Pay Transparency Statement:
This range represents the pay for this and other positions in the same pay grade. Compensation decisions depend on experience, geographic location, and internal equity.
Equal Employment Opportunity
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. 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 and regulations. We are committed to providing reasonable accommodations to individuals with disabilities and others as required by law. If you need special assistance or an accommodation during seeking employment, please email mycareer.help@bcbssc.com or call 800-288-2227, ext. 47480. We participate in E-Verify and comply with Pay Transparency nondiscrimination requirements. We are an Equal Opportunity Employer.
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