Molecular Diagnostics Medicare Medical Director - Palmetto GBA

Internal Reference Number: R1052096 Summary Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but we've been part of the national landscape for more than seven decades, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina ... and much more. We are one of the nation's leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies, allowing us to build on various business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team! Position Purpose: The Molecular Diagnostics Medicare Medical Director at Palmetto GBA oversees medical staff, analyzes utilization data, research emerging molecular technologies, and serves as a resource for providers and internal teams on policy issues. The role also includes developing, writing, and revising medical policies to ensure compliance and support Medicare coverage decisions. Description Logistics: Palmetto GBA - one of BlueCross BlueShield's South Carolina subsidiary companies. Location: This position is full-time (40-hours/week) Monday-Friday working REMOTE in the United States or ONSITE at our GPC location at 17 Technology Circle, Columbia, SC. Sponsorship: This position is not eligible for sponsorship now or in the future. What You'll Do: - Supports operations in the form of case review on both medical and regulatory matters. Develops claim adjudication criteria for situations requiring medical judgment. Provides input on issues and operational policies, processes, and procedures. - Educates staff and medical community on various aspects of medical policy and program administration. - May develop and update medical policy in consultation with appropriate regulatory personnel, medical consultants, and professional societies. Develops external relationships with the medical community and serves as liaison between these entities and the contractors. - Reviews physician and provider practice pattern analysis and other statistical data related to unusual medical service utilization. - Conducts research into new or controversial medical procedures and technology. To Qualify For This Position, You'll Need The Following: - Required Education: Doctorate degree Medical Doctor (MD) with current active license to practice medicine. - Required License and Certificate: Active state medical license and current board certification in a recognized specialty. - Required Work Experience: 5 years post graduate experience in direct patient care. - Required Skills and Abilities: Excellent verbal and written communication skills. Excellent customer service, organizational, and presentation skills.Proficiency in spelling, punctuation, and grammar. Ability to persuade, negotiate, or influence others. Ability to work as a team member as well as a leader. Knowledge of medical and utilization review techniques. - Required Software: Microsoft Office Suite. We Prefer That You Have The Following: Molecular Genetic Pathology fellowship training. Medicare experience. Experience interpreting medical evidence. Scientific training/Research experience