Medical Director (Medicare Policy)

Description

Supports operations in the form of case review on both medical and regulatory matters.
Develops claim adjudication criteria for situations requiring medical judgment.
Provides input on issues and operational policies, processes, and procedures.
Educates staff and medical community on various aspects of medical policy and program administration.
Develops external relationships with the medical community and serves as liaison between these entities and the contractors.
Reviews physician and provider practice pattern analysis and other statistical data related to unusual medical service utilization.
Conducts research into new or controversial medical procedures and technology.

To Qualify For This Position, You Will Need

• Required Education: Doctorate in a job-related field
• Required Licenses and Certificates: Active state medical license and current board certification in a recognized specialty
• Required Work Experience: 5 years post graduate experience in direct patient care
• Required Skills: 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; ability to work as a team member as well as a leader; knowledge of medical and utilization review techniques
• Required Software: Microsoft Office

What We Prefer

• Hightly inquisitive
• Advanced problem solving skills
• Medicare Part A experience
• Strong client facing, relationship building skills
• Ability to follow the Scientific Method

Our Comprehensive Benefits Package Includes

• 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
• National discounts to movies, theaters, zoos, theme parks and more

What To Expect Next

After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements.

Equal Employment Opportunity Statement

We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company.