BlueCross BlueShield of South Carolina
Senior Medical Director (Palmetto GBA)
BlueCross BlueShield of South Carolina, Oklahoma City, Oklahoma, United States
Overview
Internal Reference Number: R1045875
Summary: 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, including policy and education integration, that optimizes critical medical review cycle times. In this role 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 scheduled during our normal business hours of 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) 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 disseminating information and implementing 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 creating 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 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 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.
Preferred Qualifications
Board certified for at least 3 years.
Experience 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.
Experience in health insurance, utilization review, or a health care claims organization developing coverage or medical necessity policies.
Extensive knowledge of the Medicare program, especially coverage and payment rules.
Software & Licenses 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.
Benefits & What We Can Do for You 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 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, with priority given to those demonstrating the required qualifications.
Compensation Pay Range Information:
Range Minimum $222,723.00
Range Midpoint $334,548.00
Range Maximum $446,373.00
Pay Transparency:
This range represents the pay range for this and other positions in this pay grade. Compensation decisions depend on 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 and provide equal 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 comply with applicable federal, state and local laws and regulations. We are committed to reasonable accommodations for individuals with disabilities, including pregnant individuals and those needing accommodations for sincerely held religious beliefs, provided accommodations do not impose an undue hardship. For accommodations, please email mycareer.help@bcbssc.com or call 800-288-2227, ext. 47480. We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Some states have required postings."
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Summary: 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, including policy and education integration, that optimizes critical medical review cycle times. In this role 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 scheduled during our normal business hours of 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) 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 disseminating information and implementing 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 creating 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 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 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.
Preferred Qualifications
Board certified for at least 3 years.
Experience 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.
Experience in health insurance, utilization review, or a health care claims organization developing coverage or medical necessity policies.
Extensive knowledge of the Medicare program, especially coverage and payment rules.
Software & Licenses 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.
Benefits & What We Can Do for You 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 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, with priority given to those demonstrating the required qualifications.
Compensation Pay Range Information:
Range Minimum $222,723.00
Range Midpoint $334,548.00
Range Maximum $446,373.00
Pay Transparency:
This range represents the pay range for this and other positions in this pay grade. Compensation decisions depend on 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 and provide equal 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 comply with applicable federal, state and local laws and regulations. We are committed to reasonable accommodations for individuals with disabilities, including pregnant individuals and those needing accommodations for sincerely held religious beliefs, provided accommodations do not impose an undue hardship. For accommodations, please email mycareer.help@bcbssc.com or call 800-288-2227, ext. 47480. We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Some states have required postings."
#J-18808-Ljbffr