Medical Director – Medicare Policy

Job not on LinkedIn

🕒 June 11

🎸 Tennessee – Remote

🎸 Tennessee – Remote

⏰ Full Time

🔴 Lead

👨‍⚕️ Medical Director

👻 Ghost score 55%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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CGS Administrators, LLC

WebsiteLinkedInAll Job Openings

501 - 1000 employees

🏥 Healthcare

💼 Consulting

📦 Logistics

Healthcare • Consulting • Logistics

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

• Analyze medical review utilization data • Research new or controversial medical procedures and technology • Act as a lead resource to providers and internal staff on medical policy issues • Develop and revise Medicare medical policies • Support operations through medical and regulatory case review • Develop claim adjudication criteria requiring medical judgment • Provide input on operational policies, processes, and procedures • Educate staff and the medical community on medical policy and program administration • Consult with regulatory personnel, medical consultants, and professional societies on policy development • Develop external relationships with the medical community and serve as liaison between medical entities and contractors • Review physician and provider practice pattern analyses and statistical data related to unusual medical service utilization

🎯 Requirements

• Doctorate in a job-related field • Active state medical license • 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 • Proficiency in Microsoft Office • Applicants must be U.S. Citizens due to the security-clearance requirement • Must have high-speed, non-satellite internet and a private home office space • Not eligible for employer sponsorship now or in the future

🏖️ 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