[Hiring] Medical Director - Physiatrist @Noridian Healthcare Solutions, LLC

Role Description

The Medical Director (MD) assures clinical appropriateness and standard of care for all Medicare Administrative Contractor (MAC) activities and processes, within the boundaries of federal law, Medicare regulation and Centers for Medicare and Medicaid Services (CMS) National Coverage Determinations (NCDs), and Local Coverage Determinations (LCDs).

Essential Functions

• Develops new local contractor determinations (LCDs), complete LCD redeterminations, and participates in LCD challenges as required by contract.
• Leads policy team with research and drafting of new or revised LCDs.
• Participates in meetings/conferences/panels/forums/hearings with contractors, providers, CMS Committees, law enforcement, or other stakeholders.
• Facilitates edits for NCDs as required by contract.
• Participates in initiatives to reduce Medicare Fee for Service (FFS) improper payments, as measured by Comprehensive Error Rate Testing (CERT) error rates as required by contract.
• Provides guidance and medical advice for product or service-related activities, as required by contract.
• Provides input and guidance to Medical Review strategies and determinations and broadly to staff training and coordination as needed.
• Provides input, guidance, and participation for appeals, Administrative Law Judge (ALJ) hearings and LCD challenges.

Non-Essential Duties and Functions

• Other duties as assigned.

Qualifications

• Doctorate degree in medicine, Medical Doctor (MD) or Doctor of Osteopathy (DO).
• Unrestricted license to practice medicine or osteopathy in any U.S. state or territory, never suspended or revoked in any state or territory.
• Certification by an American Board of Medical Specialties upon hire (verification required) and may be required to maintain throughout employment.
• 5 years' experience as a Medicare provider with no restrictions, suspensions or revocations.
• Working comfort with Microsoft applications: Word, Excel, Outlook, PowerPoint.

Requirements

• Experience as a health plan medical director/Medicare medical director (preferred).
• 8 years total experience as a Medicare provider with no restrictions, suspensions or revocations (preferred).
• Formal training in evaluating and critically reviewing medical literature (preferred).
• Masters in Public Health (preferred).
• Maintenance of ABMS certification (preferred).
• Detailed working knowledge of CMS National Coverage Assessments and Determinations and Medicare and related federal legislation and regulations (preferred).
• Working knowledge of appeals processes and requirements, including re-openings, reconsiderations, and Administrative Law Judge hearings with detailed experience and federal court or administrative hearing experience (preferred).
• Working knowledge of Microsoft Access, SharePoint, and Project (preferred).
• Medical Director I specialties include but are not limited to: Dentistry, Family Medicine, Gerontology, Pediatrician, Endocrinology, Physiatry, and Internal Medicine.
• Medical Director II specialties include but are not limited to: Emergency Medicine, Pulmonary, Cardiology, and General Surgeon.

Environment and Cognitive/Physical Demands

• Office Environment.
• Ability to read, hear, speak, keyboard, reason, communicate effectively and problem solve.
• Requires prolonged sitting and telephone use.
• Requires the use of office equipment such as computers, telephones, copiers and printers.
• Infrequent lifting to 15 pounds.
• Infrequent stooping.
• Periodic travel.

Benefits

• Health, Dental and Vision Insurance.
• Voluntary Insurance Plans.
• Health Savings and Flexible Spending Accounts.
• 401k and Company Match.
• Company-paid Life Insurance.
• Education Assistance Program.
• Paid Sick Leave.
• Paid Holidays.
• Increasing PTO Accrual Plan.
• Medical/Parental/Disability Leave.
• Workers Compensation.
• Retiree Benefits.
• Employee Assistance Program.
• Financial and Health Wellness Benefits.
• Casual Dress.
• Open Office Setting.
• Online Learning System.