Chief Medical Officer – Medicare Policy

🕒 June 11

🎸 Tennessee – Remote

🎸 Tennessee – Remote

⏰ Full Time

🔴 Lead

👨‍⚕️ Medical Director

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BlueCross BlueShield of South Carolina

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1946

🏥 Healthcare

💼 Consulting

⚖️ Legal

Healthcare • Consulting • Legal

BlueCross BlueShield of South Carolina is a leading health insurance provider that offers a variety of health plans, including individual and family plans, Medicare options, and group health plans. The organization focuses on providing coverage and resources for members, employers, and healthcare providers, ensuring access to quality healthcare services. With a commitment to promoting healthier lifestyles and supporting community health, BlueCross BlueShield of South Carolina plays a vital role in the healthcare landscape of the region.

📋 Description

• Provides administrative oversight to the medical staff • Analyzes medical review utilization data • Researches new medical procedures or technology • Acts as a lead resource to providers and internal staff on issues concerning medical policies • Heavily involved in policy generation, includes the development of new policy and revision of old policy • Supports operations in the form of case review on both medical and regulatory matters • Develops claim adjudication criteria for situations requiring medical judgment • 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 • Active state medical license and 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 • Microsoft Office proficiency

🏖️ 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