[Hiring] Molecular Diagnostics Medicare Medical Director @Palmetto GBA

Role Description

The Molecular Diagnostics Medicare Medical Director at Palmetto GBA oversees medical staff, analyzes utilization data, researches emerging molecular technologies, and serves as a resource for providers and internal teams on policy issues. The role also includes developing, writing, and revising medical policies to ensure compliance and support Medicare coverage decisions.

Logistics:

• Palmetto GBA – one of BlueCross BlueShield's South Carolina subsidiary companies.
• This position is full-time (40-hours/week) Monday-Friday working REMOTE in the United States or ONSITE at our GPC location at 17 Technology Circle, Columbia, SC.
• This position is not eligible for sponsorship now or in the future.

What You’ll Do:

• 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.
• May develop and update medical policy in consultation with appropriate 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.

Qualifications

• Doctorate degree Medical Doctor (MD) with current active license to practice medicine.
• 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.
• 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 in Microsoft Office Suite.

Requirements

• Molecular Genetic Pathology fellowship training.
• Medicare experience.
• Experience interpreting medical evidence.
• Scientific training/Research experience with publication history in Molecular Diagnostics.

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.