Description

Other companies come and go, but we've been part of the national landscape for more than seven decades, with our roots firmly embedded in the South Carolina community. We are one of the nation's leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We deliver outstanding service to our customers. The Molecular Diagnostics Medicare Medical Director at Palmetto GBA oversees medical staff, analyzes utilization data, research 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.
Location: 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.
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.

Doctorate degree Medical Doctor (MD) with current active license to practice medicine.

~ Active state medical license and current board certification in a recognized specialty.

~ Required Work Experience : 5 years post graduate experience in direct patient care.

~ Excellent customer service, organizational, and presentation skills. Knowledge of medical and utilization review techniques.

~ Required Software: Microsoft Office Suite.

Molecular Genetic Pathology fellowship training.

~ Experience interpreting medical evidence.

~ Scientific training/Research experience with publication history in Molecular Diagnostics.

Subsidized health plans, dental and vision coverage

~401k retirement savings plan with company match

~ Life Insurance

~ On-site cafeterias and fitness centers in major locations

~ After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements.
After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements.
Compensation decisions within the range will be dependent upon a variety of factors, including experience, geographic location, and internal equity.
BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilities and protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations.
We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company.
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