[Hiring] Physician Advisor @BlueCross BlueShield of South Carolina

Role Description

The Physician Advisor optimizes efficient management of resources, ensuring patients are in the appropriate level of care, supporting documentation, coding improvements and compliance, and monitoring the appropriate use of diagnostic and therapeutic modalities. In this role, you will provide assessment and determination of medical necessity in case evaluation and utilization management.

The Physician Advisor collaborates with a multidisciplinary team to implement methods and develop care management protocols that optimize the use of BlueCross BlueShield of South Carolina services for all patients while ensuring quality care is provided.

Qualifications

• Medical Doctor (MD) or Osteopathic Doctor (DO) with current license to practice.
• If Psychiatry Advisor - Doctor of Psychiatry (MD) with current active medical license, without restriction.
• 8 years of broad clinical experience to include knowledge of utilization and medical review.

Requirements

• Demonstrated ability to direct multiple strategic projects.
• Excellent verbal and written communication skills.
• Excellent judgment, organizational, customer service, presentation skills.
• Excellent analytical or critical thinking skills.
• Knowledge of strategic concepts.
• Ability to persuade, negotiate, or influence others.
• Active, unrestricted medical license from the United States and in the state of hire.
• Current board certification in a recognized specialty.
• Experience with prior authorization review.
• 2 years of medical data analysis/analytical capability to interpret statistical information.
• Experience with medical oversight of quality improvement activities.
• Experience with quality committees or NCQA.
• Experience with population-based disease management or public health initiatives.
• Experience in medical management or managed care.
• 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.