Talent.com
serp_jobs.error_messages.no_longer_accepting
Medical Director (Jacksonville)

Medical Director (Jacksonville)

Ascendo ResourcesJacksonville, FL, US
job_description.job_card.variable_hours_ago
serp_jobs.job_preview.job_type
  • serp_jobs.job_card.part_time
job_description.job_card.job_description

Job Title : Medicare Contractor Medical Director (CMD)

Position Summary :

The Medicare Contractor Medical Director (CMD) provides medical leadership and decision-making in support of the Medicare program. This role serves as a liaison between the Centers for Medicare & Medicaid Services (CMS) and stakeholders, with responsibility for developing Local Coverage Determinations (LCDs), ensuring compliance with Medicare policies, reviewing medical claims, and advancing evidence-based healthcare practices.

Key Responsibilities :

Clinical Expertise & Consultation (30%)

  • Lead clinical program outreach to providers, suppliers, and beneficiaries.
  • Direct and assist in provider education and the development of clinical guidelines.
  • Stay current with medical practice and technology advancements.
  • Serve as a subject matter expert in clinical areas relevant to Medicare.
  • Provide consultation to internal staff and external stakeholders.
  • Utilize scientific literature and claims data analytics to inform medical policy and reviews.

Collaboration & Leadership (30%)

  • Partner with CMS and other Medicare contractors to develop and update policies.
  • Work with cross-functional teams to improve processes and ensure compliance.
  • Liaise with CMS staff, medical societies, and stakeholders on emerging issues.
  • Represent the organization at CMS meetings and industry events.
  • Oversee quality improvement processes, ensuring consistency and education across teams.
  • Program Integrity (20%)

  • Identify trends in inappropriate billing practices and support compliance efforts.
  • Ensure adherence to Medicare regulations, NCDs, LCDs, and guidelines.
  • Lead the full LCD development lifecycle, including revisions and provider education.
  • Collaborate with investigative teams and law enforcement when appropriate.
  • Medical Review & Appeals (10%)

  • Oversee medical review activities for claim determinations.
  • Guide the development of Medical Review Quality Assurance Programs.
  • Review complex appeals and support the appeals process, including ALJ hearings.
  • Develop and implement internal medical review guidelines.
  • Provider Education & Communication (10%)

  • Engage with providers and associations to deliver education on medical policy.
  • Educate providers on identified problem areas through one-on-one or group sessions.
  • Maintain strong professional and organizational relationships.
  • Travel as needed (typically 34 weeks per year).
  • Required Qualifications :

  • MD or DO degree from an accredited medical school.
  • Minimum of 3 years of clinical practice as an attending physician.
  • In-depth knowledge of Medicare coverage and payment rules.
  • Experience in health insurance, claims processing, or utilization review involving policy and guideline development.
  • Ability to evaluate clinical evidence and develop evidence-based coverage standards.
  • Strong communication and collaboration skills with internal and external stakeholders.
  • Public speaking and provider education experience.
  • Proficiency in MS Office and virtual meeting platforms.
  • Current, active, unrestricted license to practice medicine in at least one U.S. state or territory.
  • Board certification in a specialty recognized by the American Board of Medical Specialties for at least three years.
  • Preferred Qualifications :

  • 5+ years of clinical practice in PM&R, Internal Medicine, Oncology, Radiology, Ophthalmology, or Infectious Diseases.
  • Advanced degree (MBA, MHA, MS in Management) or coursework in medical systems management.
  • Leadership experience in organized medicine or professional associations.
  • Medical Director experience in Medicare or commercial healthcare.
  • Coding and billing expertise (HCPCS, CPT, ICD-10).
  • Experience with GRADE methodology and systematic reviews.
  • Experience working with physician groups, beneficiary organizations, or congressional offices.
  • EOC

    Ascendo is a certified minority owned staffing firm, and we welcome and celebrate diversity.

    Ascendo is an Equal Opportunity Employer and does not discriminate on the basis of race, color, religion, sex (including pregnancy and gender identity), national origin, political affiliation, sexual orientation, marital status, disability, genetic information, age, parental status, military service or any other characteristic protected by federal, state or local law

    serp_jobs.job_alerts.create_a_job

    Medical Director • Jacksonville, FL, US

    Job_description.internal_linking.related_jobs
    • serp_jobs.job_card.promoted
    Medical Director Physician - $280,000 - $350,000 / yearly

    Medical Director Physician - $280,000 - $350,000 / yearly

    DocCafeJacksonville, FL, United States
    serp_jobs.job_card.full_time
    DocCafe has an immediate opening for the following position : Physician - Medical Director in Jacksonville, Florida.Make $280,000 - $350,000 / yearly. DocCafe is the premier physician and advanced prac...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    Physician / Gastroenterology / Florida / Permanent / Associate Medical Director - Gastro - 100% Remo

    Physician / Gastroenterology / Florida / Permanent / Associate Medical Director - Gastro - 100% Remo

    eviCore healthcareJacksonville, FL, US
    serp_jobs.job_card.part_time
    Provides timely expert medical review for requests to evaluate the medical necessity of services that do not meet utilization review criteria while located in a state or territory of the United Sta...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    Physician / Oncology / Florida / Permanent / Associate Medical Director - Oncology - 100% Remote

    Physician / Oncology / Florida / Permanent / Associate Medical Director - Oncology - 100% Remote

    eviCore healthcareJacksonville, FL, US
    serp_jobs.filters.remote
    serp_jobs.job_card.part_time
    Provides timely expert medical review for requests to evaluate the medical necessity of services that do not meet utilization review criteria while located in a state or territory of the United Sta...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    Medical Director - St Augustine, Florida

    Medical Director - St Augustine, Florida

    GpacSt Augustine, Florida, United States
    serp_jobs.job_card.full_time
    serp_jobs.filters_job_card.quick_apply
    I am seeking a Medical Director for a full-service veterinary hospital that places the care, diagnosis, and treatment of pets as their primary concern. The individual in this role will manage the ho...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    Associate Medical Director

    Associate Medical Director

    ChenMedJacksonville, FL, United States
    serp_jobs.job_card.full_time
    We’re changing lives every day.For both our patients and our team members.Are you innovative and entrepreneurial minded? Is your work ethic and ambition off the charts? Do you inspire others with ...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    Medical Director Primary Care Jacksonville, FL Making over $300,000

    Medical Director Primary Care Jacksonville, FL Making over $300,000

    Optigy GroupJacksonville, FL, US
    serp_jobs.job_card.full_time
    Center Medical Director Primary Care Outpatient Jacksonville, FLCOMPENSATION : $280,000-$300,000+ Bonus Total comp.We are a physician-led and mission-driven, primary care organization, is currently ...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    Medical Director

    Medical Director

    Ascendo ResourcesJacksonville, FL, US
    serp_jobs.job_card.full_time
    Medicare Contractor Medical Director (CMD).The Medicare Contractor Medical Director (CMD) provides medical leadership and decision-making in support of the Medicare program.This role serves as a li...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
    • serp_jobs.job_card.promoted
    Physician / Psychiatry / Florida / Permanent / Psychiatric Medical Director Job

    Physician / Psychiatry / Florida / Permanent / Psychiatric Medical Director Job

    Topps RecruitingJacksonville, FL, US
    serp_jobs.job_card.full_time
    Top facility in beautiful Jacksonville, FL has an immediate opening for both a Medical Director of Psychiatry and a Psychiatry Residency Director of a new residency program.These positions are offe...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    Clinical Director

    Clinical Director

    NANA Healthcare Management, LLCSt Marys, GA, US
    serp_jobs.job_card.full_time
    serp_jobs.filters_job_card.quick_apply
    Saint Mary's Wellness Center i s seeking a Clinical Director to lead an adolescent residential treatment program.This role would include supervising a clinical team as well as provide individual, g...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    Director of Nursing

    Director of Nursing

    PruittHealthSaint Marys, GA, US
    serp_jobs.job_card.full_time
    Join the PruittHealth family, where the health and safety of our workforce is our top priority! We're not only committed to your career, we're committed to the health and safety of all our nurses.N...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_hours
    • serp_jobs.job_card.promoted
    Medical Director Physician - Competitive Salary

    Medical Director Physician - Competitive Salary

    DocCafeJacksonville, FL, United States
    serp_jobs.job_card.full_time
    DocCafe has an immediate opening for the following position : Physician - Medical Director in Jacksonville, Florida.DocCafe is the premier physician and advanced practice job board to help you advan...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    Medical Director Physician - $270,000 - $350,000 / yearly

    Medical Director Physician - $270,000 - $350,000 / yearly

    DocCafeJacksonville, FL, United States
    serp_jobs.job_card.full_time
    DocCafe has an immediate opening for the following position : Physician - Medical Director in Jacksonville, Florida.Make $270,000 - $350,000 / yearly. DocCafe is the premier physician and advanced prac...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    Specialty Medical Director

    Specialty Medical Director

    Capital Veterinary Specialists, JaxJacksonville, FL, US
    serp_jobs.job_card.full_time
    Thrive Pet Healthcare is looking to add a Veterinary Medical Director to Capital Veterinary Specialists' team!.Join our community of veterinary care providers for the support, tools, and resources ...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    Medical Director

    Medical Director

    ChenMedJacksonville, FL, United States
    serp_jobs.job_card.full_time
    We’re changing lives every day.For both our patients and our team members.Are you innovative and entrepreneurial minded? Is your work ethic and ambition off the charts? Do you inspire others with ...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    Medical Director

    Medical Director

    AIDS Healthcare FoundationJacksonville, US
    serp_jobs.job_card.full_time
    AIDS Healthcare Foundation is public health, mission-based organization with a network of services that include healthcare centers, pharmacies and wellness clinics. We are now looking for a family p...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    Medical Director (Jacksonville)

    Medical Director (Jacksonville)

    Ascendo ResourcesJacksonville, FL, US
    serp_jobs.job_card.part_time
    Medicare Contractor Medical Director (CMD).The Medicare Contractor Medical Director (CMD) provides medical leadership and decision-making in support of the Medicare program.This role serves as a li...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
    • serp_jobs.job_card.promoted
    Medical Director Physician - $280,000 - $300,000 / yearly

    Medical Director Physician - $280,000 - $300,000 / yearly

    DocCafeJacksonville, FL, United States
    serp_jobs.job_card.full_time
    DocCafe has an immediate opening for the following position : Physician - Medical Director in Jacksonville, Florida.Make $280,000 - $300,000 / yearly. DocCafe is the premier physician and advanced prac...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    Physician / Psychiatry / Florida / Permanent / Psychiatric Medical Director Needed for Employed oppo

    Physician / Psychiatry / Florida / Permanent / Psychiatric Medical Director Needed for Employed oppo

    Britt Medical SearchJacksonville, FL, US
    serp_jobs.job_card.full_time
    Health Sysytem is seeking an Psychiatric Medical Director to oversee our behavior health programs at two medical centers. Telephonic call during the week is 1 : 4.No weekend call for the Medical Direc...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    Physician / Pediatrics / Florida / Permanent / Pediatric Medical Director Physician Opening in Jacks

    Physician / Pediatrics / Florida / Permanent / Pediatric Medical Director Physician Opening in Jacks

    Integrity Healthcare...Jacksonville, FL, US
    serp_jobs.job_card.full_time
    Monday-Friday 8am to 5pm with 1 hour lunch break +1 weekend day permonth 9am to 5pm with an hour lunch (There is flexibility with hours). Seeking a detail-oriented and collaborative Medical Director...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    Clinical Director

    Clinical Director

    Aspen MedicalJacksonville, FL, US
    serp_jobs.job_card.full_time
    serp_jobs.filters_job_card.quick_apply
    Clinical Director Aspen Medical has an exciting opportunity for Clinical Directors to partner with us in providing quality medical care to patients within a transitional setting.Clinical Directors,...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30