State Licensed Medical Director

Job Summary

Providing physician leadership and quality oversight, the full-time State Licensed Medical Director will manage a team of Physician Reviewers, ensuring the productivity and quality of decisions related to Medicare Part C appeals while working remotely from anywhere in the USA.

Key responsibilities

• Direct leadership over Physician Reviewers, overseeing productivity and quality of second-level appeals related to Medicare Part C
• Ensure accurate and timely processing of higher-level appeals and perform quality audits of physician reviews
• Develop and monitor reports and data analysis to identify areas for improvement in the medical program

Required qualifications

• Graduate of an accredited medical school
• Active State license to practice medicine and board certification
• Ten years of clinical experience and five years in a medical managerial or leadership role
• At least five years of direct Medicare experience in a senior medical position related to Medicare Part C
• Extensive knowledge of Medicare regulations, claims administration, and medical review processes