Physical Medicine and Rehabilitation Medical Director

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🔥 45 minutes ago

🌲 North Carolina, South Carolina, +2 more states – Remote

🌲 North Carolina – Remote 🌴 South Carolina – Remote ⛷️ Utah – Remote 🍁 Vermont – Remote

💵 $206k - $413.5k / year

⏰ Full Time

🔴 Lead

👨‍⚕️ Medical Director

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Palmetto GBA

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1965

⚕️ Healthcare Insurance

🏛️ Government

🤝 B2B

Healthcare Insurance • Government • B2B

Palmetto GBA is one of the nation's largest providers of high-volume Medicare claims and transaction processing, contact center operations, and technical services for federal healthcare programs and commercial customers. The company serves as a Medicare Administrative Contractor (MAC) and supports enrollment, claims adjudication, provider and beneficiary services, specialized programs (e. g. , DMEPOS, Home Health & Hospice, Railroad Medicare), pricing and coding analysis, and third-party administrator functions. Headquartered in Columbia, South Carolina, Palmetto GBA operates across multiple Medicare jurisdictions and is part of the Celerian Group.

📋 Description

• Provides administrative oversight to the medical staff • Analyzes medical review utilization data • Researches new medical procedures or technology • Acts as a resource to providers and internal staff on issues concerning medical policies • 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 • Develops and updates medical policy in consultation with 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

• Doctorate in a job related field • 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 • Active state medical license and current board certification in a recognized specialty

🏖️ 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