MEDICAL DIRECTOR, MEDICARE CLINICAL POLICY
Physician leadership in Medicare fee-for-serviceFull-time, exempt | Remote from approved U.S. locations | Base salary up to $300,000, plus bonus
ABOUT THE OPPORTUNITY:
Our client helps administer Medicare Part A and Part B across a broad service area. Its physicians bring clinical judgment to coverage policy, medical review, appeals, program integrity, and education for the providers who care for Medicare beneficiaries.
We are seeking a physician leader who can evaluate evolving clinical evidence, make and communicate sound medical-necessity judgments, and improve the clarity and consistency of Medicare decisions. In the Medicare Administrative Contractor (MAC) setting, this role is known as a Contractor Medical Director. This is a full-time salaried position, not an independent-contractor engagement.
Molecular pathology remains a priority. We are also considering physicians in infectious disease, oncology, cardiology, surgical specialties, and physical medicine and rehabilitation (PM&R). Across these specialties, success depends on translating clinical evidence into practical, defensible Medicare decisions.
WHAT YOU WILL DO:
- Assess clinical studies, guidelines, emerging technologies, standards of care, and outcomes for their relevance to the Medicare population.
- Lead or contribute to local coverage policies, supporting guidance, evidence summaries, responses to comments, and provider education.
- Provide physician consultation on medical necessity, utilization, documentation, medical review, complex appeals, and clinical questions arising in claims and program-integrity work.
- Lead initiatives with clinical, coding, operations, appeals, and policy partners to improve the consistency and quality of review decisions.
- Collaborate with CMS, other Medicare contractors, providers, professional societies, and clinical experts as the work requires.
- Explain the evidence and reasoning behind decisions through clear writing, presentations, meetings, and conversations with physicians and other stakeholders.
WHAT YOU WILL BRING:
- An MD or DO degree, an active and unrestricted U.S. medical license, and eligibility for any additional licensure required for the role.
- At least three years of board certification in a relevant specialty and at least three years of independent attending-level clinical practice after training. Relevant paths include molecular pathology; another pathology or genetics background with substantial clinical molecular-diagnostics experience; infectious disease; oncology; cardiology; a surgical specialty; or PM&R.
- The ability to assess the quality and applicability of clinical evidence, consider patient outcomes and medical necessity, reach a reasoned conclusion, and explain how you got there.
- Experience taking ownership of a clinical decision or initiative. This might include a policy, guideline, care pathway, medical review process, rehabilitation or service-eligibility decision, quality program, diagnostic evaluation, or research translated into practice.
- Strong writing, presentation, and collaborative leadership skills, including the ability to discuss complex medical questions with people outside your specialty.
- Interest in work centered primarily on evidence, policy, review, and physician leadership rather than direct patient care.
EXPERIENCE THAT IS ESPECIALLY VALUABLE:
- Molecular genetic pathology, clinical genomics, molecular diagnostics, biomarkers, or precision medicine.
- Medicare fee-for-service, MAC, CMS, health-plan, utilization-review, coverage-policy, claims, or appeals experience.
- Personal involvement developing or directing evidence-based policies, guidelines, pathways, medical-necessity criteria, or clinical review processes.
- Familiarity with local or national coverage determinations, systematic reviews, GRADE, coding and billing, claims data, or provider education.
A prior MAC or payer title, direct reports, and personal authorship of a local coverage determination are not prerequisites. We welcome physicians whose transferable leadership and evidence work comes from academic medicine, a health system, rehabilitation, the VA or another federal setting, a reference laboratory, or specialty practice.
ROLE DETAILS AND APPLYING:
This position is remote from an approved U.S. location. Travel is expected to total approximately three to four weeks per year, depending on business needs. Eligibility depends on your specific work location.
Base salary is up to $300,000, plus bonus. Final compensation and bonus terms will be discussed during the process.
Please apply with a current CV or resume. If your background is clinical or academic rather than payer-based, we encourage you to highlight a policy, guideline, review, program, or other evidence-based decision you personally helped lead.
