Physician Advisor

🔥 15 hours ago

🏈 Alabama, Alaska, +44 more states – Remote

🏈 Alabama – Remote 🐻 Alaska – Remote 🌵 Arizona – Remote 🏄 California – Remote ⛰️ Colorado – Remote 🦌 Connecticut – Remote 🐊 Florida – Remote 🌺 Hawaii – Remote 🥔 Idaho – Remote 🌽 Illinois – Remote 🌾 Iowa – Remote 🌪️ Kansas – Remote 🐎 Kentucky – Remote ⚜️ Louisiana – Remote 🦞 Maine – Remote 🦬 Montana – Remote 🌾 Nebraska – Remote 🎰 Nevada – Remote 🗻 New Hampshire – Remote 🏖️ New Jersey – Remote 🌶️ New Mexico – Remote 🗽 New York – Remote 🌲 North Carolina – Remote 🌾 North Dakota – Remote 🏈 Ohio – Remote 🌪️ Oklahoma – Remote 🌲 Oregon – Remote 🦀 Maryland – Remote 🍂 Massachusetts – Remote 🚗 Michigan – Remote ❄️ Minnesota – Remote 🎸 Mississippi – Remote 🏰 Missouri – Remote 🔔 Pennsylvania – Remote ⚓ Rhode Island – Remote 🌴 South Carolina – Remote 🗿 South Dakota – Remote 🎸 Tennessee – Remote 🤠 Texas – Remote ⛷️ Utah – Remote 🍁 Vermont – Remote ⚔️ Virginia – Remote ☕ Washington – Remote ⛰️ West Virginia – Remote 🧀 Wisconsin – Remote 🦬 Wyoming – Remote

💵 $176.1k - $355k / year

⏰ Full Time

🟠 Senior

🔴 Lead

👻 Ghost score 0%

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.

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

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

• Optimize efficient management of resources and ensure patients are in the appropriate level of care • Support documentation, coding improvements, compliance, and appropriate use of diagnostic and therapeutic modalities • Provide assessment and determination of medical necessity in case evaluation and utilization management • Collaborate with multidisciplinary teams to implement care management protocols and optimize services • Communicate with hospital physicians, care coordination, and utilization management staff regarding evidence-based care and documentation • Perform pre-admission, continued stay, procedure precertification, post-service, emergency room, and individual case management reviews • Respond to clinical review assistance requests from Case Management • Apply CMS and MCG evidence-based guidelines and maintain regulatory, accreditation, and payer-policy compliance • Protect and disclose PHI according to HIPAA standards • Serve as a medical resource for quality improvement and liaison to the medical community • Advise and educate providers and internal staff on medical policies, utilization specifications, coding, and medical necessity • Research new or controversial medical procedures and technologies to recommend policy, coverage, utilization, and coding criteria • Participate in medical review policy, quality programs, and inter-reviewer reliability studies

🎯 Requirements

• Medical Doctor (MD) or Osteopathic Doctor (DO) with current license to practice • 8 years-broad clinical experience to include knowledge of utilization and medical review; experience may include paid training • Active, unrestricted medical license from the United States and in the state of hire • Current board certification in a recognized specialty • Demonstrated ability to direct multiple strategic projects • Excellent verbal and written communication skills • Excellent judgment, organizational, customer service, and presentation skills • Excellent analytical or critical thinking skills • Knowledge of strategic concepts • Ability to persuade, negotiate, or influence others • Microsoft Office • Sponsorship is not eligible now or in the future • Preferred: experience with prior authorization review • Preferred: 2 years medical data analysis/analytical capability to interpret statistical information • Preferred: experience with medical oversight of quality improvement activities • Preferred: experience with quality committees or NCQA • Preferred: experience with population based disease management or public health initiatives • Preferred: experience in medical management or managed care • Preferred: demonstrated understanding of Medicare programs

🏖️ 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