Molecular Diagnostics Medicare Medical Director - Palmetto GBA

Summary

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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

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. Description ===============

Logistics

Palmetto GBA – one of BlueCross BlueShield's South Carolina subsidiary companies.

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.

Sponsorship

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 approp