## Join a Legacy of Service and Innovation Why choose the Blue. Cross Blue. Shield of South Carolina family of companies? For over seven decades, we've been a steadfast part of the national landscape, rooted in the South Carolina community. As the largest insurer in the state, we also lead in government contract administration, operate a top-tier data processing center, and boast a diverse family of subsidiaries. At Palmetto GBA, one of our subsidiary companies, we deliver outstanding service to customers and are looking for a dedicated professional to join us. ## The Role: Molecular Diagnostics Medicare Medical Director This full-time position (40 hours per week, Monday through Friday) is available as fully remote within the United States or onsite at our GPC location in Columbia, SC. Please note that this role is not eligible for sponsorship now or in the future. As the Molecular Diagnostics Medicare Medical Director, you will oversee medical staff, analyze utilization data, research emerging molecular technologies, and serve as a resource for providers and internal teams on policy issues. You'll develop, write, and revise medical policies to ensure compliance and support Medicare coverage decisions. Your responsibilities include: - Supporting operations through case review on medical and regulatory matters - Developing claim adjudication criteria that require medical judgment - Providing input on operational policies, processes, and procedures - Educating staff and the medical community on medical policy and program administration - Updating medical policy in consultation with regulatory personnel, medical consultants, and professional societies - Building external relationships and serving as a liaison between the medical community and contractors - Reviewing physician practice pattern analysis and statistical data related to unusual medical service utilization - Conducting research into new or controversial medical procedures and technology ## What You'll Need ### Required Education and Licensure - Doctorate degree (Medical Doctor, MD) with a current active license to practice medicine - Active state medical license and current board certification in a recognized specialty ### Required Experience - 5 years of postgraduate experience in direct patient care ### Required Skills and Abilities - Excellent verbal and written communication skills - Strong customer service, organizational, and presentation skills - Proficiency in spelling, punctuation, and grammar - Ability to persuade, negotiate, or influence others - Ability to work both as a team member and as a leader - Knowledge of medical and utilization review techniques - Proficiency with Microsoft Office Suite ### Preferred Qualifications - Molecular Genetic Pathology fellowship training - Medicare experience - Experience interpreting medical evidence - Scientific training or research experience with a publication history in Molecular Diagnostics ## Compensation and Benefits The pay range for this position is $206,011 to $413,523 annually, with a midpoint of $309,767. Actual compensation is determined by factors such as experience, geographic location, and internal equity. We offer a comprehensive benefits package, including: - Subsidized health plans, dental, and vision coverage - 401k retirement savings plan with company match - Life insurance - Paid time off (PTO) - On-site cafeterias and fitness centers at major locations - Education assistance - Service recognition - National discounts on movies, theaters, zoos, theme parks, and more Benefits eligibility begins the first of the month following 28 days of employment. ## Our Commitment to Diversity and Inclusion We value a diverse and inclusive workplace and strive to provide opportunities for employees across all spectrums to develop skills, advance careers, and contribute unique abilities to our company's growth. ## Next Steps After submitting your application, our recruiting team will review your resume to ensure you meet the qualifications. This may include a brief phone interview or email to verify resume specifics and salary requirements. Management will interview the most qualified candidates, with priority given to those demonstrating required qualifications. ## Equal Opportunity Employer Blue. Cross Blue. Shield of South Carolina and our subsidiaries are committed to nondiscrimination in employment based on age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information, or any other legally protected status. As a federal contractor, we maintain affirmative action programs for individuals with disabilities and protected veterans. We provide reasonable accommodations for individuals with disabilities, pregnancy-related conditions, or sincerely held religious beliefs, provided no undue hardship. For assistance, email mycareer.help@bcbssc.com or call 800-288-2227, ext. 47480. ## About Palmetto GBA Palmetto GBA is a healthcare service administrator and one of the nation's largest providers of high-volume medical claims and transaction processing. We offer services and technology solutions to improve healthcare administration for government and corporate entities. Our diverse workforce brings expertise in data analytics, administrative services, and advanced systems. We support professional growth through training, leadership programs, and tuition assistance, and we recognize hard work with awards and financial incentives. --- _This job was found on [bandana.com](https://www.bandana.com/?utm_source=jd_attribution&utm_medium=repost)_