Medical Director – Medicare Policy

🕒 June 11

🇺🇸 United States – Remote

⏰ Full Time

🔴 Lead

👨‍⚕️ Medical Director

👻 Ghost score 55%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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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

• 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

🎯 Requirements

• 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

🏖️ 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