*This position can be worked remotely.

*Must be willing to travel to Columbia, SC at least one week per month for on-site meetings/training.

*30% 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.

*30% Educates staff and medical community on various aspects of medical policy and program administration.

*20% 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.

*10% Reviews physician and provider practice pattern analysis and other statistical data related to unusual medical service utilization.

*10% Conducts research into new or controversial medical procedures and technology.

Required Education:

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

Required Work Experience:

• Fiveyears post graduate experience in direct patient care.

Preferred:

• Medicare experience.
• Experience interpreting medical evidence.
• Molecular Genetic Pathology fellowship training.
• Scientific training/Research experience with publication history in Molecular Diagnostics.

Required Skills and Abilities:

• Excellent verbal and written communication skills.
• Excellent customer service, organizational, and presentation skills.
• Proficiency in spelling, punctuation, and grammar.
• Ability to persuade, negotiate, or influence others.
• Ability to work as a team member as well as a leader.
• Knowledge of medical and utilization review techniques.

Required Software :

• Microsoft Office.

Required License and Certificate:

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

We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer.

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 minorities, females, disabled individuals and 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 physical and mental disabilities.

If you need special assistance or an accommodation while seeking employment, please e-mail abilities@bcbssc.com or call 1-800-288-2227, ext. 43172 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.