Ascendo Resources
Senior Talent Acquisition Specialist | Recruiting, Hiring, HR Operations | Ascendo Resources
Base pay range
$115,000.00/yr - $135,000.00/yr
Additional compensation types Annual Bonus Direct message the job poster from Ascendo Resources
About the Opportunity A leading national healthcare contractor is seeking a Medical Director to provide clinical leadership and decision-making support for Medicare operations. This position plays a critical role in developing and enforcing coverage determinations, reviewing complex claims, and promoting evidence-based medical policy. The role is ideal for a physician, especially those with a background in Physical Medicine and Rehabilitation (PM&R), who wishes to transition from direct patient care into a leadership position influencing medical necessity and healthcare compliance at scale.
Key Responsibilities
Clinical Leadership:
Provide medical expertise for claim reviews, appeals, and Medicare policy development. Serve as a subject matter expert across multiple specialties.
Policy Development:
Collaborate with the Centers for Medicare & Medicaid Services (CMS) and other contractors to create, revise, and maintain Local Coverage Determinations (LCDs) and related guidance.
Program Integrity:
Identify trends in billing or compliance issues and work with investigative teams to address improper claims.
Medical Review & Appeals:
Oversee quality assurance in pre- and post-payment medical review determinations and assist with administrative law proceedings when necessary.
Provider Education:
Lead outreach and training for healthcare providers and professional associations to ensure adherence to Medicare policies and evidence-based practices.
Travel is minimal (approximately 3–4 weeks per year), and the position is fully remote with occasional in-person meetings or conferences.
Required Qualifications
MD or DO from an accredited institution.
Active, unrestricted medical license in at least one U.S. state (must be eligible for additional licensure where required).
Board Certification in a specialty recognized by the American Board of Medical Specialties (minimum three years).
At least three years of experience as an attending physician.
Prior experience within the Medicare, health insurance, or utilization review environment.
Strong understanding of clinical evidence evaluation and medical necessity determination within fee-for-service structures.
Excellent communication and collaboration skills across technical, regulatory, and clinical teams.
Computer proficiency (MS Office, data analysis tools, virtual collaboration platforms).
Preferred Qualifications
Background in PM&R, Internal Medicine, Oncology, Radiology, Ophthalmology, or Infectious Disease.
Five or more years of clinical practice experience.
Prior experience as a Medical Director in a Medicare or commercial payer organization.
Familiarity with HCPCS, CPT, and ICD-10 coding standards.
Advanced degree or coursework in healthcare administration or systems management (MBA, MHA, MS).
Experience performing systematic literature reviews or using GRADE methodology.
Base salary:
Approximately $300,000, flexible depending on experience.
Bonus structure:
Significant performance-based bonuses.
Benefits:
Comprehensive health coverage, generous retirement contributions, paid time off, and strong professional development support.
Schedule:
Full-time, remote position with flexible hours.
Why Join This is an opportunity to move beyond clinical work while continuing to make a direct impact on patient access and policy integrity at a national level. Join a mission-driven organization that values medical expertise, promotes collaboration, and advances fairness and compliance within the U.S. healthcare system.
#J-18808-Ljbffr
Additional compensation types Annual Bonus Direct message the job poster from Ascendo Resources
About the Opportunity A leading national healthcare contractor is seeking a Medical Director to provide clinical leadership and decision-making support for Medicare operations. This position plays a critical role in developing and enforcing coverage determinations, reviewing complex claims, and promoting evidence-based medical policy. The role is ideal for a physician, especially those with a background in Physical Medicine and Rehabilitation (PM&R), who wishes to transition from direct patient care into a leadership position influencing medical necessity and healthcare compliance at scale.
Key Responsibilities
Clinical Leadership:
Provide medical expertise for claim reviews, appeals, and Medicare policy development. Serve as a subject matter expert across multiple specialties.
Policy Development:
Collaborate with the Centers for Medicare & Medicaid Services (CMS) and other contractors to create, revise, and maintain Local Coverage Determinations (LCDs) and related guidance.
Program Integrity:
Identify trends in billing or compliance issues and work with investigative teams to address improper claims.
Medical Review & Appeals:
Oversee quality assurance in pre- and post-payment medical review determinations and assist with administrative law proceedings when necessary.
Provider Education:
Lead outreach and training for healthcare providers and professional associations to ensure adherence to Medicare policies and evidence-based practices.
Travel is minimal (approximately 3–4 weeks per year), and the position is fully remote with occasional in-person meetings or conferences.
Required Qualifications
MD or DO from an accredited institution.
Active, unrestricted medical license in at least one U.S. state (must be eligible for additional licensure where required).
Board Certification in a specialty recognized by the American Board of Medical Specialties (minimum three years).
At least three years of experience as an attending physician.
Prior experience within the Medicare, health insurance, or utilization review environment.
Strong understanding of clinical evidence evaluation and medical necessity determination within fee-for-service structures.
Excellent communication and collaboration skills across technical, regulatory, and clinical teams.
Computer proficiency (MS Office, data analysis tools, virtual collaboration platforms).
Preferred Qualifications
Background in PM&R, Internal Medicine, Oncology, Radiology, Ophthalmology, or Infectious Disease.
Five or more years of clinical practice experience.
Prior experience as a Medical Director in a Medicare or commercial payer organization.
Familiarity with HCPCS, CPT, and ICD-10 coding standards.
Advanced degree or coursework in healthcare administration or systems management (MBA, MHA, MS).
Experience performing systematic literature reviews or using GRADE methodology.
Base salary:
Approximately $300,000, flexible depending on experience.
Bonus structure:
Significant performance-based bonuses.
Benefits:
Comprehensive health coverage, generous retirement contributions, paid time off, and strong professional development support.
Schedule:
Full-time, remote position with flexible hours.
Why Join This is an opportunity to move beyond clinical work while continuing to make a direct impact on patient access and policy integrity at a national level. Join a mission-driven organization that values medical expertise, promotes collaboration, and advances fairness and compliance within the U.S. healthcare system.
#J-18808-Ljbffr