Medical Director (Medicare)
J
JobgetherHealthcare
Based in the United StatesFull-TimeDirector
Salary not disclosed
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Job Details
- Experience
- At least four years of professional medical practice experience
- Required Skills
- SharePointMicrosoft Excel
Requirements
- Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) degree with active medical licensure.
- Board certification.
- At least four years of professional medical practice experience.
- Extensive knowledge of Medicare programs, including coverage rules, payment policies, and regulatory requirements.
- Experience working in healthcare insurance, utilization review, claims processing, or similar healthcare policy environments.
- Strong understanding of medical documentation, coding guidelines, and healthcare compliance requirements.
- Excellent communication, collaboration, and decision-making skills with the ability to work effectively across diverse stakeholder groups.
- Proficiency with technology tools including Microsoft Word, Excel, SharePoint, and web-based meeting platforms.
- Ability to operate effectively in a remote, team-oriented environment.
- Experience developing medical necessity guidelines, coverage policies, or clinical review standards preferred.
- Experience presenting to physician organizations, beneficiary groups, government stakeholders, or healthcare industry audiences preferred.
Responsibilities
- Provide medical expertise and oversight for Medicare claims review determinations, including complex medical necessity and coverage evaluations.
- Review and interpret medical documentation, clinical guidelines, CMS policies, regulations, and coding resources to support accurate decisions.
- Serve as a medical representative and spokesperson when engaging with medical societies, physician groups, stakeholders, and industry organizations.
- Maintain current knowledge of medical practice standards, healthcare technologies, Medicare requirements, and evolving regulatory guidance.
- Support the development, review, and improvement of contractor policies, written guidelines, and operational procedures.
- Collaborate with leadership teams to identify Medicare payment vulnerabilities, improper payment drivers, and opportunities for program improvement.
- Provide input on proposed policy changes, payment methodologies, and national healthcare coverage issues.
- Coordinate educational sessions and knowledge-sharing activities for medical review staff and healthcare professionals.
- Work with external partners and healthcare organizations to align policy development and share best practices.
- Prepare reports, documentation, and updates according to established quality and compliance requirements.
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