Senior Medical Review Director - Stop Loss Focus

About the role

Lead, organize, and develop staff in administration of the Medical Review and Prior Authorization programs for commercial stop loss programs.This role Directs and oversees the Medical Review and Prior Authorization programs ensuring performance expectations, compliance standards, workload issues, quality control, training and maintaining effective staffing levels and budgetary limits. Works collaboratively with owned division and program partners in the development and implementation of an efficient and effective Medical Review Strategy, including the integration of policy and education, that optimizes critical Medical Review cycle times. Serves as the Medical Review and Prior Authorization liaison between internal and external stakeholders. Why should you join the BlueCross BlueShield of South Carolina family of companies? 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 the largest insurance company in South Carolina ... and much more. 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 also have a diverse family of subsidiary companies, allowing us to build on various business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team! Position Purpose: Lead, organize, and develop staff in administration of the Medical Review and Prior Authorization programs for commercial stop loss programs.This role Directs and oversees the Medical Review and Prior Authorization programs ensuring performance expectations, compliance standards, workload issues, quality control, training and maintaining effective staffing levels and budgetary limits. Works collaboratively with owned division and program partners in the development and implementation of an efficient and effective Medical Review Strategy, including the integration of policy and education, that optimizes critical Medical Review cycle times. Serves as the Medical Review and Prior Authorization liaison between internal and external stakeholders. Logistics: https://www.companionlife.com/ - one of BlueCross BlueShield of South Carolina's subsidiary companies. Location: This is a remote position. Typical work hours are from 8:30am - 5pm, Monday through Friday.