Medical Director, Molecular Pathology
Medicare clinical policy | Full-time exempt | Remote
Anticipated base salary: $200,000 to $300,000, plus bonus | Travel: approximately 3 to 4 weeks annually
About the opportunity
Our client is a large organization operating within the Medicare Administrative Contractor (MAC) environment. It supports Medicare Part A and Part B claims operations, appeals, provider education, and program integrity across a broad service footprint.
To support rapidly evolving molecular diagnostics, the organization is seeking a physician leader with deep molecular pathology expertise to evaluate clinical evidence and help shape defensible Medicare coverage, review, coding guidance, and provider education.
This is a primarily non-patient-facing role for a molecular pathologist who can answer the questions that matter in coverage policy: Is the test analytically sound? Is it clinically valid? Does its use improve decisions or outcomes for the Medicare population? Can the rationale be explained clearly to providers, reviewers, CMS, and other stakeholders?
Strong candidates may come from academic medicine, an integrated health system, a reference laboratory, precision oncology, clinical genomics, or a federal or provider environment. Prior MAC or payer employment is valued, but it is not required.
Important: A prior Medical Director title, direct reports, LCD authorship, and payer employment are not prerequisites. The foundation is true molecular pathology depth, evidence translation, scientific writing, and demonstrated ownership.
The work
Most of your time will center on clinical consultation and collaborative policy leadership, with additional responsibility for program integrity, medical review and appeals, and provider education.
- Serve as the physician subject matter expert for molecular pathology, genetic testing, and genomic diagnostics in the Medicare fee-for-service environment.
- Evaluate analytic validity, clinical validity, clinical utility, evidence quality, standards of care, and relevance to the Medicare population.
- Lead or contribute to Local Coverage Determinations, associated billing and coding articles, response-to-comment documents, medical review positions, and related policy guidance.
- Assess evolving technologies such as DNA and RNA testing, next-generation sequencing, gene panels, biomarkers, liquid biopsy and ctDNA, germline and somatic testing, companion diagnostics, and proprietary assays.
- Analyze claims, utilization, documentation, and coding or billing patterns to identify medical necessity gaps, aberrant utilization, improper payment, and program integrity risks.
- Provide physician judgment for complex medical review, appeals, denial rationale, position papers, and administrative proceedings as needed.
- Collaborate with internal clinical, operational, coding, compliance, appeals, and program integrity teams, as well as CMS, peer Medicare contractors, provider groups, professional societies, and external experts.
- Translate complex molecular evidence and Medicare policy into clear provider education, internal training, public presentations, and written guidance.
- Promote consistency and quality in physician review decisions and related clinical processes.
What we are looking for
- MD or DO degree.
- Current, active, unrestricted U.S. medical license and the ability to obtain any additional licensure required for the role.
- Relevant ABMS-recognized board certification and at least three years of attending-level or equivalent independent physician practice.
- Direct molecular pathology specialization demonstrated through one of the following routes:
- Molecular Genetic Pathology board certification with relevant clinical molecular practice.
- An accredited Molecular Genetic Pathology fellowship plus relevant physician board certification.
- Board certification in Anatomic Pathology, Clinical Pathology, AP/CP, or Clinical Genetics and Genomics, combined with sustained physician leadership in clinical molecular diagnostics, genomic test interpretation, and clinical application.
- Substantial clinical experience in one or more molecular application areas, such as molecular oncology and solid-tumor genomics, molecular hematopathology, inherited or germline disease, molecular infectious disease, pharmacogenomics, or broad molecular diagnostics. Expertise across every domain is not expected.
- Demonstrated ability to appraise scientific literature and make clear judgments about clinical utility, medical necessity, and evidence strength.
- Strong scientific writing, presentation, and communication skills, including the ability to explain complex clinical rationale clearly and defensibly.
- Evidence of leadership and ownership. This may include program, fellowship, rotation, section, committee, laboratory, quality, research, guideline, grant, or major initiative leadership. A formal Medical Director title is not required.
- Practical exposure to how documentation, medical necessity, coding, billing, utilization, and reimbursement affect molecular testing. This experience may come from provider, laboratory, health system, federal, or payer settings.
- Interest in moving into a full-time role centered on evidence, policy, review, program integrity, and stakeholder communication rather than direct patient care.
Preferred, not required
- Molecular oncology, tumor genomics, biomarker, ctDNA, or companion diagnostic depth is especially relevant, but the search is not limited to oncology applications.
- Experience with a Medicare Administrative Contractor, CMS, Medicare fee-for-service, a commercial payer, utilization management, medical review, or coverage policy.
- Experience with LCD or NCD frameworks, technology assessment, systematic review, GRADE methodology, guideline development, or formal evidence synthesis.
- Working knowledge of CPT, HCPCS, ICD-10, PLA codes, Tier 1 and Tier 2 molecular pathology procedures, genomic sequencing procedure codes, or laboratory reimbursement.
- Experience with claims review, appeals, administrative hearings, program integrity, improper payment analysis, or provider audit work.
- Professional society, consensus panel, guideline, editorial, coding committee, digital pathology, informatics, or data analytics leadership.
Role details
- Employment: Full-time, exempt, and primarily non-patient-facing. In the Medicare context, Contractor Medical Director is a physician leadership designation within the contractor organization, not a 1099 engagement.
- Work model: Remote from an approved U.S. work location.
- Priority hiring states: Alabama, Florida, Georgia, Mississippi, North Carolina, South Carolina, and Texas. Pennsylvania may be considered outside Philadelphia. Additional approved locations may be available after verification.
- Compensation: Anticipated base salary of $200,000 to $300,000, plus bonus. The final base salary will reflect experience, credentials, and approved work location.
- Travel: Approximately 3 to 4 weeks per year, based on business needs.
How to apply
Apply with a current CV or resume. Please do not self-select out solely because you have not worked for a payer or have not previously written an LCD. Qualified academic and provider-side molecular pathologists are encouraged to apply. Licensure, board details, and location eligibility will be verified during the recruiter screen.
This is an opportunity to extend deep molecular pathology expertise beyond a single laboratory or health system and help influence evidence-based Medicare policy, responsible payment, and provider understanding at scale.
