Contractor Medical Director CMD 300071

* Position is eligible for remote/work from home opportunity

Job Summary

The Contractor Medical Director (CMD) 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 & Medicaid Services (CMS) National Coverage Determinations (NCDs), and explains, teaches, and represents these criteria, activities, and processes to all stakeholders, as appropriate.

Key Performance Indicators

• Knowledge of clinical issues related to CMS
• Strong interpersonal and clinical skills
• Ability to teach and train others and effectively work with multiple and varied stakeholders

Essential Functions

Key Duties/Responsibilities/Accountabilities

• Develops new local contractor determinations (LCDs), complete LCD redeterminations, and participates in LCD challenges as required by contract.
• 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.

Requirements

Qualifications:

Minimum Qualifications

• Doctorate degree in medicine, MD or 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-recognized organization
• 3 years' experience as a Medicare provider with no restrictions, suspensions or revocations
• History of Drug Enforcement Administration licensure without restrictions, suspensions or revocations
• Working comfort with Microsoft applications: Word, Excel, Outlook, PowerPoint

Preferred Qualifications:

• Experience as a health plan medical director/Medicare medical director
• Maintenance of ABMS certification
• Detailed working knowledge of CMS National Coverage Assessments and Determinations and Medicare and related federal legislation and regulations
• 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
• Working knowledge of Microsoft Access, SharePoint, and Project

Environment and Cognitive/Physical Demands

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

Segregation of Duties

Every employee is responsible to perform their duties and responsibilities in accordance with Noridian values, policies and procedures, including but not limited to, Segregation of Duties Principles, HIPAA Security and Privacy, CMS requirements, the Noridian Compliance Program, and any other applicable laws, rules and regulations.



Other Information

Job Posting Policy 6.05

New employees with Noridian Healthcare Solutions will be eligible to apply for positions within their assigned department after successfully completing a 90-day review. For positions outside your department, you must attain a minimum of six months of service before you can apply.

Equal Employment Opportunity
Equal Opportunity Employer of Minorities, Females, Protected Veterans and Individual with Disabilities, as well as Sexual Orientation or Gender Identity.

For questions, please email careers@noridian.com.

This job posting will be closed 12/28/18 at 8:00AM CST. No further applications will be considered.