Chief Medical Director, Medicare & Medicaid Programs

Opportunity Overview

We invite qualified professionals to consider a full-time, remote opportunity with our organization. In this role, you will utilize your clinical expertise to evaluate and support review activities while collaborating with Medical Directors from various contractors. Keeping abreast of advancements in medical practices and technologies is crucial to ensure correct billing and payment determinations. You will also have the responsibility of providing final conclusions on any questionable payment decisions.

This position plays a vital role in supporting the Health & Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS) in their commitment to serve the public by promoting health equity, expanding coverage, and enhancing health outcomes.

Key Responsibilities

• Apply clinical expertise to guide review activities and offer direction to review staff.
• Collaborate with Medical Directors from other contractors as the situation demands.
• Remain informed about updates in medical practices and technology to mitigate improper billing.
• Deliver final review decisions regarding questionable payment determinations.
  
  

Qualifications

• At least three years of experience as a board-certified physician, with a clean record in relation to Medicare sanctions or exclusions.
• Experience in the health insurance sector, utilization review firms, or other healthcare claims processing organizations, particularly in developing coverage or medical necessity policies and guidelines.
• Comprehensive understanding of the Medicare program, including rules governing coverage and payment.
• Background in public relations, especially working with physician groups, beneficiary organizations, and congressional offices.
  
  

Education and Licensure

• Doctor of Medicine (MD) or Doctor of Osteopathy (DO) degree.
• Current medical licensure is required.
  
  

We celebrate diversity and are committed to creating an inclusive environment for all employees. All qualified applicants will be considered for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status. We also do not discriminate based on disability.

Employment Type: Full-Time