Data Entry Question and Answer

$150 $49

Remote Question and Answer

$150 $49

Virtual Assistant Question and Answer

$150 $49

Content Moderator Question and Answer

$150 $49

Customer Service Question and Answer

$150 $49

Video Game Tester Question and Answer

$150 $49

Senior Medical Director (Palmetto GBA)

Other Jobs To Apply

No other job posts for this day.

Summary

Position Purpose: As a member of the leadership team, you will oversee and direct the synthesis of data and clinical knowledge in the development of information used to inform the detection, correction and prevention of claims payment errors. You will lead a Medical Review team in the development and implementation of an efficient and effective medical review strategy which includes the integration of policy and education, and you will serve as the Medical Review liaison between internal and external stakeholders.

Logistics

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

Location: This position is full-time (40 hours/week), MondayFriday. An 8-hour shift is scheduled during normal business hours (8:00 AM5:00 PM). Travel between buildings may be required. This role is remote in the US or onsite at the Government Programs Building at 17 Technology Circle, Columbia, SC, United States.

What Youll Do

  • Oversee the development, implementation and communication of Medical Review strategy and the optimization of critical Medical Review cycle times.
  • Direct and oversee the development of effective Local Coverage Determinations (LCDs) aimed at addressing identified or preventing potential widespread claims payment errors.
  • Collaborate with internal stakeholders to address priority areas identified in the Medical Review Strategy.
  • Assist the VP in engaging external stakeholders to disseminate information and implement process improvements in support of the Medical Review Strategy.

Qualifications

Required Education: Doctorate in a job-related field.

Required Experience:

  • 10 years of experience.

Required Skills and Abilities:

  • Demonstrated effectiveness in creating information that informs strategic and management decisions.
  • Knowledge/experience in directing and participating in the development of medical coverage policy.
  • Strong analytical, judgment, presentation, critical thinking, organizational and planning skills.
  • Ability to adapt to changing business environment and priorities.
  • Working knowledge of statistical concepts, population statistics and analysis methods.
  • Excellent verbal and written communication skills.
  • Demonstrated medical systems knowledge/experience.
  • Ability to work with diverse range of individuals (clinicians, suppliers and employees) and exercise good judgment.
  • Ability to work in a dynamic environment with minimal supervision.
  • Ability to lead as well as collaborate as a team member.
  • Knowledge of medical and utilization review techniques.
  • Ability to comprehend government regulatory and political structures.

Required Software: Microsoft Office Software

Required License and Certificate: If Medical Doctor (MD) or Doctor of Osteopathy (DO), active state medical license and current board certification in a recognized specialty.

Preferred Qualifications

  • Board certified for at least 3 years
  • Experience with physician groups, beneficiary organizations, and/or congressional offices is preferred
  • Prior clinical practice as an attending physician
  • MBA or business degree
  • Strong business acumen
  • Geriatrician or experience with geriatric population
  • Experience in health insurance industry, utilization review, or claims processing with policy development experience
  • Extensive knowledge of the Medicare program, especially coverage and payment rules

Benefits

Comprehensive benefits: Subsidized health plans, dental and vision coverage; 401(k) with company match; Life Insurance; Paid Time Off (PTO); On-site cafeterias and fitness centers in major locations; Education Assistance; Service Recognition; National discounts.

What We Can Do for You

We value a diverse and inclusive workplace and strive to be an employer where employees across all spectrums can develop skills, advance careers and contribute their unique abilities to the company's growth.

What to Expect Next

After submitting your application, our recruiting team will review your resume to confirm qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements. Management will interview the most qualified candidates, prioritizing those who meet the required qualifications.

Pay Information

Pay Range: Minimum $222,723.00; Midpoint $334,548.00; Maximum $446,373.00

Pay Transparency Statement: This range represents pay for this and other positions at this pay grade. Compensation decisions depend on experience, geographic location, and internal equity.

Equal Employment Opportunity

BlueCross BlueShield of South Carolina and our subsidiaries are committed to nondiscrimination in employment and comply with applicable laws. We provide reasonable accommodations where required and are an equal opportunity employer. E-Verify and Pay Transparency provisions apply.


#J-18808-Ljbffr
Back to blog

Yelp Question and Answer

$150 $49

Amzon Question and Answer

$150 $49

Netflix Question and Answer

$150 $49

Disney Question and Answer

$150 $49

Apple Question and Answer

$150 $49

Southwest Airline Q & A

$150 $49

Delta Airline Q & A

$150 $49

Costco Question and Answer

$150 $49

American Question and Answer

$150 $49

Walmart Question and Answer

$150 $49

Tesla Question and Answer

$150 $49

Google Question and Answer

$150 $49

Common Interview Questions And Answers

1. HOW DO YOU PLAN YOUR DAY?

This is what this question poses: When do you focus and start working seriously? What are the hours you work optimally? Are you a night owl? A morning bird? Remote teams can be made up of people working on different shifts and around the world, so you won't necessarily be stuck in the 9-5 schedule if it's not for you...

2. HOW DO YOU USE THE DIFFERENT COMMUNICATION TOOLS IN DIFFERENT SITUATIONS?

When you're working on a remote team, there's no way to chat in the hallway between meetings or catch up on the latest project during an office carpool. Therefore, virtual communication will be absolutely essential to get your work done...

3. WHAT IS "WORKING REMOTE" REALLY FOR YOU?

Many people want to work remotely because of the flexibility it allows. You can work anywhere and at any time of the day...

4. WHAT DO YOU NEED IN YOUR PHYSICAL WORKSPACE TO SUCCEED IN YOUR WORK?

With this question, companies are looking to see what equipment they may need to provide you with and to verify how aware you are of what remote working could mean for you physically and logistically...

5. HOW DO YOU PROCESS INFORMATION?

Several years ago, I was working in a team to plan a big event. My supervisor made us all work as a team before the big day. One of our activities has been to find out how each of us processes information...

6. HOW DO YOU MANAGE THE CALENDAR AND THE PROGRAM? WHICH APPLICATIONS / SYSTEM DO YOU USE?

Or you may receive even more specific questions, such as: What's on your calendar? Do you plan blocks of time to do certain types of work? Do you have an open calendar that everyone can see?...

7. HOW DO YOU ORGANIZE FILES, LINKS, AND TABS ON YOUR COMPUTER?

Just like your schedule, how you track files and other information is very important. After all, everything is digital!...

8. HOW TO PRIORITIZE WORK?

The day I watched Marie Forleo's film separating the important from the urgent, my life changed. Not all remote jobs start fast, but most of them are...

9. HOW DO YOU PREPARE FOR A MEETING AND PREPARE A MEETING? WHAT DO YOU SEE HAPPENING DURING THE MEETING?

Just as communication is essential when working remotely, so is organization. Because you won't have those opportunities in the elevator or a casual conversation in the lunchroom, you should take advantage of the little time you have in a video or phone conference...

10. HOW DO YOU USE TECHNOLOGY ON A DAILY BASIS, IN YOUR WORK AND FOR YOUR PLEASURE?

This is a great question because it shows your comfort level with technology, which is very important for a remote worker because you will be working with technology over time...

Related Posts