Impress employers and recruiters.
Choose from hundreds of resume examples.
Impress employers and recruiters.
Choose from hundreds of resume examples.
Tailor your resume to this Behavioral Health Medical Director role.
Rezi rewrites your resume against BlueCross BlueShield of South Carolina's job description. Free.
Tailor your resume to this Behavioral Health Medical Director role.
Rezi rewrites your resume against BlueCross BlueShield of South Carolina's job description. Free.
Don't guess if your resume is good enough.
See how it scores against the Behavioral Health Medical Director posting at BlueCross BlueShield of South Carolina — free, in seconds.
Don't guess if your resume is good enough.
See how it scores against the Behavioral Health Medical Director posting at BlueCross BlueShield of South Carolina — free, in seconds.
About the Role
The Behavioral Health Medical Director provides medical leadership to specific health plan or LOB, overseeing physician review, utilization review/quality assurance, case management, and medical policies. This role identifies trends in medical management and proactively aids in setting direction to improve them, ensuring alignment with state priorities and goals for improved care transitions and reduced emergency department dependence.
Responsibilities
- Provides leadership and medical support on medical and regulatory matters.
- Identifies trends in medical and pharmacy costs and utilization, making recommendations for solutions.
- Leads clinical teams and operations to increase compliance, improve efficiency, and enhance communication.
- Acts as a resource for providers, staff, medical reviewers, and customers on medical policies and regulations.
- Provides clinical support to Payment Integrity Units for abuse pattern analysis and solution recommendation.
- Oversees quality improvement and health plan and medical program accreditation.
- Collaborates with staff and leadership on quality initiatives, clinical support, and network outreach.
- Responsible for physician review (UM, Appeals, CM), including practice pattern analysis and statistical data review.
- Conducts research into new or controversial medical procedures and technology.
- Educates staff, network providers, and the medical community on medical policy and program administration.
Requirements
- Doctorate Degree - Medical Doctor (MD) with current active medical license, without restriction.
- If Behavioral Health, Doctor of Psychiatry with current active medical license, without restriction.
- 8 years post graduate experience in direct patient care.
- Managed care knowledge and experience required.
- Working knowledge of regulatory and accreditation entities (URAC, NCQA, DOI, and DOL standards).
- 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, and represent the company well.
- Ability to work as a team member as well as a leader.
- Active, unrestricted medical license from the United States and in the state of hire.
- Current board certification in a recognized specialty.
Skills
- Managed care knowledge
- Knowledge of regulatory and accreditation entities
- Excellent verbal and written communication
- Excellent customer service
- Excellent organizational skills
- Excellent presentation skills
- Good judgment
- Proficiency in spelling, punctuation, and grammar
- Ability to persuade, negotiate, or influence
- Ability to work as a team member
- Ability to work as a leader
- Strong knowledge of Medicaid programs, regulations and compliance
- Ability to develop and maintain positive relationships
- Demonstrated ability to drive continuous improvement
- Demonstrated ability to drive cost reduction
- Ability to effectively collaborate with cross-functional teams
- Executive level presentation skills
Location
- South Carolina
Work Type
- Full-time
- Remote
Experience Level
- 8 years post graduate experience in direct patient care
Education Level
- Doctorate Degree - Medical Doctor (MD)
- Doctor of Psychiatry
- Psychiatry residency completion
- Specialty in Child and Adolescent Psychiatry preferred
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
- BlueCross BlueShield of South Carolina has been part of the national landscape for over seven decades, with roots in the South Carolina community.
- It is the largest insurance company in South Carolina and a leading administrator of government contracts.
- The company operates a sophisticated data processing center in the Southeast and has a diverse family of subsidiary companies.
- They deliver outstanding service to their customers.
Equal Opportunity
- BlueCross BlueShield of South Carolina and its subsidiary companies maintain a continuing policy of nondiscrimination in employment based on 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.
- The company is 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.
- The company participates in E-Verify and complies with the Pay Transparency Nondiscrimination Provision.
- They are an Equal Opportunity Employer.