About the job
Medical Director (Medicare Contractor Medical Director)
Compensation: $185,000 to $264,000 base (+ bonus), commensurate with experience
Work model: Primarily remote with limited travel (approximately 3 to 4 weeks per year)
A national healthcare organization supporting the Medicare fee-for-service program is seeking an experienced physician leader to serve as a Medicare Contractor Medical Director. This role offers the opportunity to influence coverage policy, medical review quality, and program integrity at scale while collaborating with federal partners and clinical stakeholders.
The Medical Director provides clinical leadership and medical decision-making oversight across Medicare programs. This position plays a central role in evidence-based policy development, claims review, provider education, and regulatory compliance.
Responsibilities:
- Serve as a clinical subject matter expert for Medicare medical policy, coverage, and medical necessity determinations
- Lead and contribute to the development, revision, and education of Local Coverage Determinations (LCDs)
- Provide clinical consultation on complex or non-standard claims, medical reviews, and appeals
- Collaborate with CMS and other Medicare contractors to align policy with regulatory and clinical evidence
- Support program integrity initiatives, including fraud, waste, abuse, and billing anomaly identification
- Oversee medical review quality programs and promote consistency in claim determinations
- Support administrative appeals through position paper development and policy guidance
- Educate and engage the provider community and interdisciplinary stakeholders
Day in the Life:
- A combination of daily claim reviews, appeals support, and longer-term coverage and policy initiatives
- Exposure to emerging technologies and evolving Medicare coverage questions
- Ongoing collaboration with federal agencies, clinical reviewers, legal teams, and investigative partners
Required Qualifications:
- MD or DO from an accredited medical school with active, unrestricted U.S. medical licensure
- Board certification in an ABMS-recognized specialty with several years of independent clinical practice experience
- Demonstrated experience applying clinical judgment within Medicare-related environments, including medical policy, utilization review, or claims decision-making
Preferred Qualifications:
- 5+ years of clinical practice, particularly in PM&R, Internal Medicine, Oncology, Radiology, Ophthalmology, or Infectious Diseases
- Prior Medical Director experience in Medicare-related or commercial healthcare organizations
- Advanced degree or formal training in healthcare or systems management (MBA, MHA, MS)
- Experience with HCPCS, CPT, and ICD-10 coding and billing
- Familiarity with GRADE methodology, literature evaluation, or systematic reviews
- Leadership experience within organized medicine, professional societies, or multidisciplinary committees
Why This Opportunity:
- High-impact physician leadership role shaping Medicare coverage and policy decisions
- Direct collaboration with CMS and other federal stakeholders
- Balanced mix of clinical, analytical, and strategic work
- Competitive executive-level compensation with limited travel requirements
If you are a physician/leader seeking to apply your clinical expertise at a national level while maintaining a flexible work model, this role offers a compelling next step.
