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About the Role

As a member of the senior management team, the Physical Medicine and Rehabilitation Medical Director provides administrative oversight to the medical staff, analyzes medical review utilization data, researches new medical procedures or technology, and acts as a resource to providers and internal staff on issues concerning medical policies. May also write and revise medical policies.

Responsibilities

• 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.

Requirements

• 5 years post graduate experience in direct patient care.
• Active state medical license and current board certification in a recognized specialty.
• Health insurance industry experience
• Experience in INPATIENT Rehabilitation
• Medicare policy knowledge and experience

Skills

• Microsoft Office
• Excellent verbal and written communication skills.
• Excellent customer service, organizational, and presentation skills.
• Good judgment 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.

Location

• REMOTE in the United States
• ONSITE at our GPC location at 17 Technology Circle, Columbia, SC

Work Type

• full-time (40-hours/week)
• Monday-Friday
• REMOTE
• ONSITE

Experience Level

• senior management team

Education Level

• Doctorate in a job related field.

Salary/Compensations

• $206,011.00 - $413,523.00

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

About the Company

• Palmetto GBA – one of BlueCross BlueShield's South Carolina subsidiary companies.
• 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.

Equal 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.
• Additionally, as a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilities and 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.
• We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision.
• We are an Equal Opportunity Employer.