Chief Medical Officer – Medicare Policy

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🎸 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

• Provides administrative oversight to medical staff • Analyzes medical review utilization data • Researches new medical procedures or technology • Acts as a lead resource to providers and internal staff on medical policies • Heavily involved in policy generation, developing new policy and revising old policy • Supports operations in case review on medical and regulatory matters • Develops claim adjudication criteria for medical judgment situations • 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 regulatory personnel, medical consultants, and professional societies • Develops external relationships with the medical community and serves as liaison between these entities and contractors • Reviews physician and provider practice pattern analysis and 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