[Hiring] Medical Director @AMDEX Corporation

Role Description

AMDEX Corporation’s subsidiary company, Avar Consulting, is seeking a Medical Director for its contract with the Center for Medicare and Medicaid Services.

• Conducting audits, namely beneficiary appeals, in specific BFCC-QIO service areas to determine if the BFCC-QIO's operations, programs, or projects in these service areas are functioning effectively and efficiently.
• These audits will include a review of a designated number of cases per contracted service area.
• The audits shall include IRR of beneficiary appeals to measure the level of agreement between BFCC-QIO decisions and the contractor’s decisions.
• On an annual basis, the contractor shall perform IRR reviews on:
  • 2,000 cases each for Medicare FFS Post-Acute Appeals and MA Post-Acute Appeals.
  • 1,100 cases each for Hospital Discharge Appeals and Hospital Observation Status Appeals.

Qualifications

• Licensed Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) in the United States (Note: Licensure must be verified annually).
• Experience in patient care and medical peer review.
• Experience overseeing medical care in healthcare organizations or facilities.
• Experience coordinating medical care, developing, and evaluating resident care policies.
• Knowledge of current and emerging healthcare industry trends.
• Ability to advise on physician and clinical practice issues.
• Ability to ensure systems exist for sound medical care, monitoring, documentation, and compliance with regulations.
• Ability to mentor and influence positive change.
• Excellent oral and written communication skills.
• Knowledge of Medicare coverage and payment policies.
• Experience educating staff on Medicare policy and review application.
• Experience in collaborating with physician and nurse reviewers according to Medicare policy.

Company Description

• Beneficiary and Family Centered Care Quality Improvement Organizations (BFCC QIOs) help Medicare beneficiaries exercise their right to high-quality health care, by managing beneficiary complaints and quality of care (QoC) reviews, as well as handling cases in which beneficiaries want to appeal a health care provider’s decision to discharge them from a hospital or discontinue other types of services.
• Avar has contributed significantly to the BFCC QIO program’s evolution across the last several years and was the first ever small business to win a QIO contract.
• Avar has incorporated analytics and data-driven improvements, innovation, and collaboration to deliver and drive beneficiary oversight, protection, and engagement.
• As the BFCC National Coordinating Oversight & Review Center (BFCC-NOCRC), Avar has played a crucial role in advancing CMS’ strategic agenda.
• Avar is a woman-owned small business specializing in program evaluation and policy assessment; survey research; data collection, management, analysis, and reporting; and ancillary information technology and communication support services.
• Avar is a wholly owned subsidiary of AMDEX Corporation.
• Avar holds similar analytics contracts with HHS, DOL, and Dept of Education.
• AMDEX Corporation is a Women Owned Small Business with over 35 years supporting government agencies; HHS, NIH, CDC, Department of Homeland Security, Census Bureau.