Director, Senior Medical (Palmetto GBA)
Director, Senior Medical (Palmetto GBA)
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Job Description
Summary
Position PurposeAs 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 this role you will also serve as the Medical Review liaison between internal and external stakeholders.
Description
Logistics: Palmetto GBA one of BlueCross BlueShields 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 8:00AM-5:00PM. You may be required to travel between buildings. This role is ONSITE located at our Government Programs Building at 17 Technology Circle Columbia SC in the United States.
What Youll 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 Youll 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 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 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.
Our comprehensive benefits package includes the following:
We offer our employees great benefits and rewards. You will be eligible to participate in the benefits the first of the month following 28 days of employment.
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.
Equal Employment Opportunity Statement
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 individuals with disabilitiesand protected 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 and regulations.
We are committed to working with and providing reasonable accommodations to individuals with disabilities pregnant individuals individuals with pregnancy-related conditions and individuals needing accommodations for sincerely held religious beliefs provided that those accommodations do not impose an undue hardship on the Company.
If you need special assistance or an accommodation while seeking employment please email or call ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable 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. Heres moreinformation.
Some states have required notifications. Heres more information.
Required Experience:
Director
Employment Type
Full-Time
