Molecular Diagnostics Medicare Medical

JOB REQUIREMENTS: Internal Reference Number: R1048417 Summary As memberof the senior management team, provides administrative oversight to themedical staff, analyzes medical review utilization data, researches newmedical procedures or technology, and acts as a resource to providersand internal staff on issues concerning medical policies. May also writeand revise medical policies.Description Location: This position isfull-time (40-hours/week) Monday-Friday-Hourly). This position can beworked remotely. Position Purpose: The Molecular Diagnostics MedicareMedical Director at Palmetto GBA oversees medical staff, analyzesutilization data, research emerging molecular technologies, and servesas a resource for providers and internal teams on policy issues. Therole also includes developing, writing, and revising medical policies toensure compliance and support Medicare coverage decisions. What You'llDo: Supports operations in the form of case review on both medical andregulatory matters. Develops claim adjudication criteria for situationsrequiring medical judgment. Provides input on issues and operationalpolicies, processes, and procedures. Educates staff and medicalcommunity on various aspects of medical policy and programadministration. May develop and update medical policy in consultationwith appropriate regulatory personnel, medical consultants, andprofessional societies. Develops external relationships with the medicalcommunity and serves as liaison between these entities and thecontractors. Reviews physician and provider practice pattern analysisand other statistical data related to unusual medical serviceutilization. Conducts research into new or controversial medicalprocedures and technology. To Qualify For This Position, You'll NeedThe Following: Required Education:Doctorate degree Medical Doctor (MD)with current active license to practice medicine. Required License andCertificate: Active state medical license and current boardcertification in a recognized specialty. Required Work Experience:Fiveyears post graduate experience in direct patient care. RequiredSkills and Abilities: Excellent verbal and written communicationskills.... For full info follow application link. BlueCross BlueShieldof South Carolina and our subsidiary companies maintain a continuingpolicy of nondiscrimination in employment to promote employmentopportunities for persons regardless of age, race, color, nationalorigin, sex, religion, veteran status, disability, weight, sexualorientation, gender identity, genetic information or any other legallyprotected status. Additionally, as a federal contractor, the companymaintains Affirmative Action programs to promote employmentopportunities for minorities, females, disabled individuals andveterans. It is our policy to provide equal opportunities in all phasesof the employment process and to comply with applicable federal, stateand local laws and regulations. APPLICATION INSTRUCTIONS:Apply Online: ipc.us/t/5BE6FB92D2424667

Created: 2026-02-20