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Behavioral Health Medical Director
BlueCross BlueShield of South Carolina. Provide medical leadership and support on medical and regulatory matters .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in medical leadership, regulatory compliance, and quality assurance within managed care settings. Proven ability to develop and implement medical policies, evaluate new technologies, and lead clinical teams to enhance patient care and health equity.
Highest-signal resume keywords
Doctorate Degree – Medical Doctor (MD)8 Years Post Graduate Experience in Direct Patient CareManaged Care Knowledge and ExperienceCurrent Board Certification in a Recognized SpecialtyWorking Knowledge of Regulatory and Accreditation Entities
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Medical LeadershipUtilization ReviewQuality AssuranceCase ManagementClinical OversightPolicy DevelopmentCost and Utilization AnalysisBehavioral Health Strategy AlignmentEvidence-Based Utilization DecisionsQuality Improvement Initiatives
Soft Skills
Excellent Verbal and Written Communication SkillsCustomer Service SkillsOrganizational SkillsPresentation SkillsGood Judgment Skills
Certifications & Qualifications
Active Medical LicenseCurrent Board Certification
Industry Keywords
Managed CareURACNCQADOI StandardsDOL StandardsHealth EquityBehavioral HealthCrisis ResponseTransitions-of-Care StrategiesPopulation Health
About the role
Key responsibilities & impact- Provide medical leadership and support on medical and regulatory matters
- Oversee physician review, utilization review, quality assurance, and case management
- Develop and implement medical policies and standards
- Evaluate new technologies and treatments
- Identify medical and pharmacy cost and utilization trends and recommend solutions
- Provide clinical oversight for behavioral health activities across utilization management, care coordination, quality, and population health for South Carolina Medicaid
- Align Healthy Blue’s behavioral health strategy with SCDHHS priorities and statewide goals
- Make defensible, evidence-based utilization decisions and review complex and high-cost cases
- Partner with program integrity teams to identify inappropriate utilization patterns
- Lead integrated behavioral health/medical models, suicide prevention, crisis response, and transitions-of-care strategies
- Advance health equity across South Carolina’s rural and urban regions
- Lead clinical teams and operations to improve compliance, efficiency, and communication
- Support Payment Integrity units by analyzing abuse patterns and recommending solutions
- Oversee quality improvement and health plan and medical program accreditations
- Develop quality initiatives and provide clinical support and network outreach
- Perform physician review for utilization management, appeals, and case management
- Research new or controversial medical procedures and technologies
- Educate staff, network providers, and the medical community on medical policy and program administration
Requirements
What you’ll need- Doctorate Degree – Medical Doctor (MD) with current active medical license, without restriction; for Behavioral Health Medical Director, Doctor of Psychiatry with current active medical license, without restriction
- 8 years post graduate experience in direct patient care
- Managed care knowledge and experience required
- Working knowledge of regulatory and accreditation entities, including URAC, NCQA, DOI, and 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 and represent the company well
- Ability to work as a team member and leader
- Active, unrestricted medical license from the United States and in the state of hire
- Current board certification in a recognized specialty
- Position is not eligible for sponsorship now or in the future
Benefits
Comp & perks- 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
- Diverse and inclusive workplace
- Reasonable accommodations for individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs