Medical Director – Medicare Policy

🕒 il y a 3 mois

🇺🇸 États-Unis – Télétravail

⏰ Temps Plein

🔴 Expert

👨‍⚕️ Directeur Médical

👻 Score fantôme 55%

Ce que ça veut dire : la probabilité que cette offre reste ouverte sans recrutement actif.Comment le lire : 60 % ou plus, on pense que c'est une offre fantôme. Un score plus bas est moins inquiétant.Comment on la calcule : ancienneté, republications, postes ouverts vs taille de l'équipe, rapidité de clôture, et si le salaire est indiqué.À noter : une estimation à partir de données publiques, pas un jugement sur l'entreprise. De vraies offres peuvent avoir un score élevé, alors prenez-le comme un indice, pas comme un fait.

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BlueCross BlueShield of South Carolina

Site WebLinkedInTous les Emplois

10 000+ employés

Fondée en 1946

🏥 Santé

💼 Conseil

⚖️ Juridique

Healthcare • Consulting • Legal

description traduite de l'entreprise

Description

• Analyze medical review utilization data • Research new or controversial medical procedures and technology • Act as a lead resource to providers and internal staff on medical policy issues • Develop and revise Medicare medical policies • Support operations through case review on medical and regulatory matters • Develop claim adjudication criteria requiring medical judgment • Provide input on operational policies, processes, and procedures • Educate staff and the medical community on medical policy and program administration • Consult with regulatory personnel, medical consultants, and professional societies on policy development • Develop external medical-community relationships and serve as liaison with contractors • Review physician and provider practice-pattern analyses and statistical data concerning unusual medical service utilization

🎯 Exigences

• Doctorate in a job-related field • Active state medical license • Current board certification in a recognized specialty • 5 years post graduate experience in direct patient care • 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 • Proficiency with Microsoft Office • Ability to obtain a security clearance • U.S. Citizenship required for security clearance • Not eligible for sponsorship now or in the future

🏖️ Avantages

• 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