Medical Director (Medicare)

The Medical Director (Medicare) role is based in the United States and is managed by a partner company. Key responsibilities include providing clinical insight, regulatory guidance, and medical expertise to support Medicare claims review processes and healthcare program initiatives. This role requires collaboration with medical professionals, stakeholders, and leadership teams to ensure accurate, compliant, and effective healthcare decisions.

Requirements

• A board-certified physician with significant clinical experience and deep knowledge of Medicare policies, healthcare regulations, and medical review processes.
• Strong analytical abilities, communication skills, and experience working with healthcare organizations.
• No current or previous adverse actions from Medicare, Medicaid, federal or state programs, medical insurance programs, or medical licensing boards.
• Experience working in healthcare insurance, utilization review, claims processing, or similar healthcare policy environments.
• Experience developing medical necessity guidelines, coverage policies, or clinical review standards preferred.
• 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.
• Experience presenting to physician organizations, beneficiary groups, government stakeholders, or healthcare industry audiences preferred.
• Proficiency with technology tools including Microsoft Word, Excel, SharePoint, and web-based meeting platforms.
• Ability to operate effectively in a remote, team-oriented environment.

Benefits

• Competitive compensation package based on experience, qualifications, and role alignment.
• Fully remote work opportunity within the United States.
• Opportunity to influence healthcare programs and Medicare operations on a national scale.
• Collaborative environment working with healthcare professionals and industry stakeholders.
• Professional growth opportunities through impactful healthcare initiatives.
• Access to technology tools and resources needed to support remote work.