Behavioral Health Medical Director
About the role
BlueCross BlueShield of South Carolina has been part of the national landscape for more than seven decades, with deep roots in the South Carolina community. As the state’s largest insurance company and a leading administrator of government contracts, we operate one of the most sophisticated data processing centers in the Southeast and maintain a diverse family of subsidiary companies. We deliver outstanding service to our customers. The Behavioral Health Medical Director provides medical leadership for a specific health plan or line of business, overseeing physician review, utilization review/quality assurance, directing case management, developing and implementing medical policies and standards, evaluating new technologies and treatments, and identifying trends to improve medical management.
Responsibilities
- Provides leadership and medical support on medical and regulatory matters.
- Identifies trends in medical and pharmacy costs, utilization trends, and proactively makes recommendations and initiates solutions to impact these.
- Provides leadership to clinical team and operations to increase compliance, improve efficiency, and increase communication.
- Acts as a resource for providers, staff, part‑time medical reviewers, and customers on issues concerning medical policies and regulations.
- Provides clinical support to Payment Integrity Unit(s) to analyze abuse patterns and recommend solutions.
- Provides oversight and leadership with quality improvement and health plan and medical program accreditation(s).
- Works with staff and other leadership in developing ideas related to quality initiatives, good clinical support, and outreach to the network.
- Responsible for physician review (UM, Appeals, CM) – reviews physician and provider practice pattern analysis and other statistical data.
- Conducts research into new or controversial medical procedures and technology.
- Educates staff, network providers, and the medical community on various aspects of medical policy and program administration.
Requirements
Required Education: Doctorate Degree – Medical Doctor (MD) with current active medical license, without restriction. If Behavioral Health, Medical Director – Doctor of Psychiatry with current active medical license, without restriction.
Required Work Experience: 8 years post‑graduate experience in direct patient care.
Required License and Certificates: Active, unrestricted medical license from the United States and in the state of hire and current board certification in a recognized specialty.
Skills
- Managed care knowledge and experience required.
- Working knowledge of regulatory and accreditation entities (URAC, NCQA, DOI, DOL standards).
- Excellent verbal and written communication skills.
- Excellent customer service, organizational, and presentation skills.
- Good judgment skills.
- Proficiency in spelling, punctuation, and grammar.
- Ability to persuade, negotiate, or influence others; represent the company well.
- Ability to work as a team member as well as a leader.
Qualifications
Preferred: Doctorate Degree – Medical Doctor (MD) with current active South Carolina medical license, without restriction. Completion of a Psychiatry residency with preference for specialty in Child and Adolescent Psychiatry. Strong knowledge of Medicaid programs, regulations and compliance. Ability to develop and maintain positive relationships with peers, enterprise, customers, and partners. Demonstrated ability to drive continuous improvement and cost reduction. Ability to effectively collaborate with cross‑functional teams. Executive level presentation skills. Experience working with the SC Department of Health and Human Services.
Benefits
- 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 in major locations
- Education Assistance
- Service Recognition
- National discounts to movies, theaters, zoos, theme parks and more
Pay
Pay Range Information: Range Minimum $206,011.00, Range Midpoint $309,767.00, Range Maximum $413,523.00.
Pay Transparency Statement: This range represents the pay range for this and other positions that fall into this pay grade. Compensation decisions within the range will be dependent upon a variety of factors, including experience, geographic location, and internal equity.
Schedule
Location: This position is full‑time (40‑hours/week) Monday‑Friday REMOTE in South Carolina. You will be required to come to on‑site twice monthly.
Sponsorship: This position is not eligible for sponsorship now or in the future.