Chief Medical Officer – Medicare Policy

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🔥 12 hours ago

🎸 Tennessee – Remote

🎸 Tennessee – Remote

⏰ Full Time

🔴 Lead

👨‍⚕️ Medical Director

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CGS Administrators, LLC

WebsiteLinkedInAll Job Openings

501 - 1000 employees

⚕️ Healthcare Insurance

🤝 B2B

Healthcare Insurance • B2B • Fraud Prevention

CGS Administrators, LLC is a company that provides scalable administrative services focused on optimizing operational performance and reducing costs for health plans. With over 50 years of experience, CGS delivers a range of services including credentialing, member services, claims processing, and fraud prevention to the Centers for Medicare & Medicaid Services (CMS) and various healthcare providers. Their aim is to streamline operations and enhance customer satisfaction, contributing positively to the healthcare delivery system.

📋 Description

• Supports operations in the form of case review on both medical and regulatory matters. • Develops claim adjudication criteria for situations requiring medical judgment. • Provides input on issues and operational policies, processes, and procedures. • Educates staff and medical community on various aspects of medical policy and program administration. • May develop and update medical policy in consultation with appropriate regulatory personnel, medical consultants, and professional societies. • Develops external relationships with the medical community and serves as liaison between these entities and the contractors. • Reviews physician and provider practice pattern analysis and other statistical data related to unusual medical service utilization. • Conducts research into new or controversial medical procedures and technology.

🎯 Requirements

• Doctorate in a job-related field • Active state medical license and current board certification in a recognized specialty. • 5 years post graduate experience in direct patient care. • Excellent verbal and written communication skills. • Excellent customer service, organizational, and presentation skills. • Good judgment skills. • Proficiency in spelling, punctuation, and grammar. • Ability to persuade, negotiate, or influence others. • Ability to work as a team member as well as a leader. • Knowledge of medical and utilization review techniques. • Microsoft Office proficiency

🏖️ Benefits

• Subsidized health plans, dental and vision coverage • 401k retirement savings plan with company match • Life Insurance • Paid Time Off (PTO) • On-site cafeterias and fitness centers in major locations • Education Assistance • Service Recognition • National discounts to movies, theaters, zoos, theme parks and more