Chief Medical Officer, Contractor Medical Director

Palmetto GBA, a subsidiary of BlueCross BlueShield of South Carolina, is seeking a contracted Medical Director to serve as part of the senior management team. The role centres on clinical oversight of medical staff, analysis of utilisation data, and acting as an internal resource on medical policy matters. The position is based onsite in Columbia, SC, working standard business hours Monday to Friday.

Candidates must be U.S. citizens eligible to obtain a government security clearance. The role involves developing claim adjudication criteria, researching emerging procedures and technologies, and reviewing provider practice patterns to identify unusual utilisation or potential fraud, waste, and abuse. Preferred specialisations include cardiology, rheumatology, and internal medicine, with Medicare policy experience an advantage.

• Provide clinical and administrative oversight to medical staff and review cases on medical and regulatory matters
• Develop and update claim adjudication criteria where medical judgement is required
• Write and revise medical policies in consultation with regulatory personnel, consultants, and professional societies
• Educate staff, providers, and the broader medical community on policy and programme administration
• Build and maintain external relationships with the medical community, serving as a liaison to contractors
• Analyse physician and provider practice patterns and statistical data to identify unusual service utilisation

• Doctorate in a relevant field (medical degree required)
• Active state medical licence and current board certification in a recognised specialty
• Minimum 5 years post-graduate direct patient care experience (10+ preferred)
• U.S. citizenship with the ability to obtain a government security clearance
• Strong knowledge of medical and utilisation review techniques
• Proficiency in Microsoft Office and strong written and verbal communication skills

BlueCross BlueShield of South Carolina is the state's largest insurance company and a leading administrator of government contracts. Operating for more than seven decades, the organisation manages one of the most sophisticated data processing centres in the Southeast and operates a diverse portfolio of subsidiary companies, including Palmetto GBA.