Chief Medical Officer (Medicare Policy)

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Ourhrconnect · W@h, TN

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About the role

As member of the senior management team, provides administrative oversight to the medical staff, analyzes medical review utilization data, researches new medical procedures or technology, and acts as a lead resource to providers and internal staff on issues concerning medical policies. Heavily involved in policy generation to include the development of new policy and the revision of old policy. 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! Logistics CGS (cgsadmin.com) - one of BlueCross BlueShield's South Carolina subsidiary companies. Location: This position is full time (40 hours/week) Monday through Friday . This is a W@H opportunity and can be located anywhere within the U.S. To work from home, you must have high-speed, non-satellite internet and a private home office space. Government Clearance: This position requires the ability to obtain a security clearance, which requires applicants to be a U.S. Citizen. Sponsorship : This position is not eligible for sponsorship now or in the future.

Responsibilities

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.

To Qualify for This Position, You Will Need:

Required Education: Doctorate in a job-related field

Required Licenses and Certificates: Active state medical license and current board certification in a recognized specialty.

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

Required Software: Microsoft Office.

What We Prefer:

Highly inquisitive, Self-Starter

Advanced problem solving skills

Medicare Part A experience

Strong client facing, relationship building skills

Ability to follow the Scientific Method

Involvement in AMA, AAFP, AAPL

Our Comprehensive Benefits Package Includes The Following:

We offer our employees great benefits and rewards. You will be eligible to participate in the benefits the first of the month following 28 days of employment.

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

What We Can Do for You:

We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company.

What To Expect Next:

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.

Equal Employment Opportunity Statement

Chief Medical Officer (Medicare Policy)

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