BlueCross BlueShield of South Carolina
Senior Medical Director (Palmetto GBA)
BlueCross BlueShield of South Carolina, Los Angeles, California, United States
Internal Reference Number: R1045875
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 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 integration and education, that optimizes critical medical review cycle times. You will also serve as the Medical Review liaison between internal and external stakeholders.
Location & Logistics Logistics:
Palmetto GBA – one of BlueCross Blue Shield\'s South Carolina 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 in the 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) aimed at addressing identified or preventing potential widespread claims payment errors.
Collaborate with internal stakeholders to address priority areas identified in the Medical Review Strategy.
Assist the VP to engage external stakeholders in efforts to disseminate information and implement process improvements in support of the Medical Review Strategy.
Qualifications
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 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 state medical license and current board certification in a recognized specialty.
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.
Compensation & Benefits Our comprehensive benefits package includes the following:
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 conduct interviews with the most qualified candidates, prioritizing those 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 range for this and other positions in this pay grade. Compensation decisions will depend on a variety of factors, including 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. As a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilities and protected veterans. We are committed to equal opportunity in all phases of the employment process and to complying with applicable laws and regulations.
We are committed to providing reasonable accommodations to individuals with disabilities, pregnant individuals, and those needing accommodations for sincerely held religious beliefs, provided the accommodations do not impose an undue hardship on the Company. If you need special assistance or an accommodation, please email mycareer.help@bcbssc.com or call 800-288-2227, ext. 47480 with the nature of your request. We will determine accommodations 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.
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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 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 integration and education, that optimizes critical medical review cycle times. You will also serve as the Medical Review liaison between internal and external stakeholders.
Location & Logistics Logistics:
Palmetto GBA – one of BlueCross Blue Shield\'s South Carolina 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 in the 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) aimed at addressing identified or preventing potential widespread claims payment errors.
Collaborate with internal stakeholders to address priority areas identified in the Medical Review Strategy.
Assist the VP to engage external stakeholders in efforts to disseminate information and implement process improvements in support of the Medical Review Strategy.
Qualifications
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 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 state medical license and current board certification in a recognized specialty.
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.
Compensation & Benefits Our comprehensive benefits package includes the following:
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 conduct interviews with the most qualified candidates, prioritizing those 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 range for this and other positions in this pay grade. Compensation decisions will depend on a variety of factors, including 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. As a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilities and protected veterans. We are committed to equal opportunity in all phases of the employment process and to complying with applicable laws and regulations.
We are committed to providing reasonable accommodations to individuals with disabilities, pregnant individuals, and those needing accommodations for sincerely held religious beliefs, provided the accommodations do not impose an undue hardship on the Company. If you need special assistance or an accommodation, please email mycareer.help@bcbssc.com or call 800-288-2227, ext. 47480 with the nature of your request. We will determine accommodations 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