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Director, Medical Director
Found in: Jooble US O C2 - 5 days ago
Lexington Medical Center West Columbia, SC, United States Full timeLexington Medical Cancer Center is seeking a highly skilled Hematologist/Oncologist with clinical leadership experience . This Physician will serve in a primarily clinical role with the added responsibility of serving as Practice Medical Director . This is an exceptional opportun ...
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Medical Director
Found in: Lensa US 4 C2 - 4 days ago
The VET Recruiter West Columbia, United StatesWe are seeking an · experienced · Medical Director · to · lead · a team of passionate, focused doctors. Our client · is an AAHA-accredited, small animal practice in beautiful Charleston, South Carolina. · For over 40 years, the · clinic has served the community with excep ...
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medical director
Found in: MyJobHelper US C2 - 2 days ago
AID Upstate , SC, United StatesJob Type · Full-time · Description · SEEKING · We are looking for someone to provide direction for and monitoring of healthcare delivery services offered by our organization within the context of a team setting while acting as a responsible leader, expert practitioner, educator/t ...
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medical director
Found in: MyJobHelper US C2 - 2 days ago
Centene Corporation , SC, United StatesYou could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. ...
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Medical Director
Found in: Lensa US 4 C2 - 2 days ago
State of North Carolina North Carolina, United States*** SIGN-ON BONUES NOW BEING OFFERED888 · A Sign-on bonus of $20,000 for the successful applicant(s) of this posting. · ***See eligibility for Sign-on Bonus below in the Supplemental and Contact Information section.** · ***Per G.S c1) (37), this position is Exempt from all provi ...
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Medical Director
Found in: Talent US 2A C2 - 1 day ago
Prisma Health Columbia, United StatesSouth Carolina Children's Advocacy Medical Response System - Medical Director · Columbia, SC · The University of South Carolina School of Medicine (USCSOM) is seeking a board - certified child abuse pediatrician to provide programmatic oversight of the SC Children's Advocacy Med ...
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Associate Medical Director/Medical Director
Found in: Talent US C2 - 2 days ago
Thermo Fisher Scientific North Carolina, United States Full timeOverview: Provides medical oversight of clinical trials to ensure company SOPs, client directives, good clinical practice, and regulatory requirements are followed. Attends and presents at investigator and sponsor meetings, provides medical consultation to clients, investigators ...
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psychiatrist - medical director
Found in: MyJobHelper US C2 - 2 days ago
Liberty Healthcare Corporation , SC, United StatesJob Description · A full-time Medical Director position is now available with Liberty Healthcare at the Catawba Community Mental Health Center. · The Catawba Community Mental Health Center provides high quality outpatient services to children, adolescents, adults, and families wh ...
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medical director veterinarian
Found in: MyJobHelper US C2 - 2 days ago
Get a Vet Staffing , SC, United StatesJob Description · Full Time Medical Director Veterinarian · Compassionate, Team Player and Strong Communicator · Proficient in general medicine and surgery · Experience preferred but new graduates seeking mentorship are encouraged to apply · Requirements · Doctor of Veterinary de ...
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Director Medical Affairs
Found in: Appcast Linkedin GBL C2 - 1 day ago
Brio Group North Carolina, United StatesJob Title: Medical Affairs Director - MSLs · Company: Oncology Biotech · Location: Remote, East Coast · Brio Resource Group is a Life Sciences Executive Search Firm committed to providing rare talent on an exclusive search basis to the Biopharma, Pharma, Device and CRO industries ...
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Center Medical Director
Found in: Jooble US O C2 - 2 days ago
Oak Street Health Columbia, SC, United StatesDescription Title: Center Medical Director · Location: Openings in Columbia, Greenville, and Spartanburg (SC). For a list of all applicable centers, see Role Description: The purpose of a Primary Care Physician at Oak Street Health is to provide equitable and effective value ...
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center medical director
Found in: MyJobHelper US C2 - 2 days ago
CSL Plasma , SC, United States**Our Benefits** · We encourage you to make your well-being a priority. It's important and so are you. Learn more about how we care ) at CSL. · **About CSL Plasma** · CSL Plasma is one of the world's largest collectors of human plasma. Our work helps to ensure that people with ra ...
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Licensed Physician/Medical Director
Found in: Appcast US C2 - 1 day ago
Lincare South Carolina, United StatesAs America's largest supplier of respiratory and durable medical equipment, Lincare's mission is to set the standard for excellence, transforming the way respiratory care is delivered in the home. We are inspired by a vision to enable patients with chronic conditions to remain en ...
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Senior Center Medical Director
Found in: MyJobHelper US C2 - 5 days ago
ChenMed Columbia, United States Full timeWe're unique. You should be, too. · We're changing lives every day. For both our patients and our team members. Are you innovative and entrepreneurial minded? Is your work ethic and ambition off the charts? Do you inspire others with your kindness and joy? · We're different than ...
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senior center medical director
Found in: MyJobHelper US C2 - 2 days ago
ChenMed South Carolina, USA, United StatesWe're unique. You should be, too. · We're changing lives every day. For both our patients and our team members. Are you innovative and entrepreneurial minded? Is your work ethic and ambition off the charts? Do you inspire others with your kindness and joy? · We're different than ...
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Associate Medical Director, Client Support
Found in: Lensa US 4 C2 - 5 days ago
BlueCross BlueShield of South Carolina West Columbia, United StatesProvides direct physician support. Oversees health and disease management programs. Oversees utilization management case evaluation for medical necessity. Reviews and communicates medical decisions. Interacts with network physician providers to resol Medical Director, Client Supp ...
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Hospitalist Medical Director in Walterboro, SC
Found in: Lensa US 4 C2 - 4 days ago
TeamHealth West Columbia, United StatesHospitalist Medical Director in Walterboro, SC · in · Walterboro, SC · at · TeamHealth · Job Description Advance your career as a TeamHealth hospitalist medical director TeamHealth cultivates leaders to guide their teams toward goals like client retention and patient satisfa ...
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psychiatric medical director opportunity in sc
Found in: MyJobHelper US C2 - 2 days ago
Hayman Daugherty Associates, Inc , SC, United StatesJob Overview · Psychiatric Medical Director Opportunity in South Carolina A facility in South Carolina is seeking a Psychiatric Medical Director to oversee their behavioral health programs. Qualifications: Must be board certified in Psychiatry. Must have or be able to obtain a SC ...
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psychiatric medical director opportunity in sc
Found in: MyJobHelper US C2 - 2 days ago
Hayman Daugherty Associates, Inc , SC, United StatesJob Overview · Psychiatric Medical Director locums opportunity in South Carolina · The facility is seeking a Psychiatric Medical Director to oversee the behavior health programs. · Must be board certified in Psychiatry · Must have or be able to obtain a SC Medical License prior t ...
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medical director role in columbia sc
Found in: MyJobHelper US C2 - 2 days ago
The Curare Group , SC, United StatesA Cancer Center situated in central South Carolina is actively seeking a proficient Hematologist/Oncologist with significant clinical leadership experience to assume the role of Practice Medical Director. This presents a remarkable prospect for a forward-thinking and clinically a ...
Associate Medical Director - West Columbia, United States - BlueCross BlueShield of South Carolina
Found in: Lensa US 4 C2 - 2 days ago
Description
Associate Medical Director - Concierge Care Management page is loadedAssociate Medical Director - Concierge Care Management
Apply
locations
Columbia, South Carolina
time type
Full time
posted on
Posted 3 Days Ago
job requisition id
R1034326
Summary
Provides direct physician support. Oversees health and disease management programs. Oversees utilization management case evaluation for medical necessity. Reviews and communicates medical decisions. Interacts with network physician providers to resolve case-by-case complaints. Oversees medical aspects of vendor relationships. Assists in developing medical policy.
Description
Provides medical and administrative oversight of the health and disease management programs including budgeting, program strategic planning, and review of outgoing correspondence and printed materials.
Provides presentations on health and disease management as assigned.Provides direct physician support. Assists in compliance with regulatory bodies.
Performs utilization management review functions including pre-admission review, continues stay review, procedure precertification, post-service reviews, emergency room visit reviews, and individual case management needs.
Serves as medical resource for quality improvement and National Committee for Quality Assurance (NCQA) and Health Plan Employer Data and Information Set (HEDIS) initiatives.
Acts as resource for providers/internal staff on medical policies. Educates providers on issues concerning medical policies, utilization specifications, coding/medical necessity issues. Conducts research into new/controversial medical
procedures/technology
as assigned to propose possible policy, coverage criteria, utilization specifications and coding recommendations.
Participates in medical review policy/quality programs and inter-reviewer reliability studies.
Maintains familiarity with applicable regulations (state, federal) as well as any oversight agency/entity rules such as National Committee for Quality Assurance (NCQA), Department of Insurance (DOI), or URAC.
Additional:
Complex Care/Case Management Review
Support clinical nursing team in daily operations
Perform peer to peer communication with facility providers
Lead case management clinical rounds
High-cost claimant data gathering and analysis
Forward facing meetings for High-cost claimant reviews
Clinical strategy meetings
Present semi-annual and annual reviews on plan performance
Required Education:
Doctorate in a job related field
Required Work Experience : 8 years broad clinical experience to include knowledge of utilization and medical review. Experience may include paid training.
Required Skills and Abilities:
Demonstrated ability to direct multiple strategic projects. Excellent verbal and written communication skills. Excellent judgment, organizational, customer service, presentation skills. Excellent analytical or critical thinking skills. Knowledge of strategic concepts. Ability to persuade, negotiate, or influence others. Working knowledge of word processing, spreadsheet, and presentation software.
Required Software and Tools:
Microsoft Office.
Required Licenses and Certificates:
Active, unrestricted medical license from the United States and in the state of hire and current board certification in a recognized specialty.
Preferred Education:
Bachelor's degree- Business Administration or Public Health
Preferred Work Experience:
2 years-medical data analysis/analytical capability to interpret statistical information.
Preferred Experience:
Inpatient or previous Healthcare Case Management oversight experience preferred Care Management Physician Certification or Other formal Case Management training preferred.
Preferred Skills and Abilities:
Experience with medical oversight of quality improvement activities. Experience with quality committees or NCQA. Experience with population based disease management or public health initiatives. Experience in medical management or managed care. Demonstrated understanding of Medicare programs.
Work Environment:
Typical office environment. Extended periods of sitting, working at personal computer. Some walking, standing, moving of boxes.
We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer.
Some states have required notifications. Here's more information
.
Equal Employment Opportunity Statement
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
or call , ext with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.
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