Medical Director

Medical Director – Medicare | Molecular PathologyRemote – United StatesWe are seeking a board-certified physician with expertise in Molecular Pathology for a remote Medical Director opportunity supporting the Medicare program.This position combines clinical expertise with Medicare medical policy, coverage determination, medical review, and provider education. The Medical Director will evaluate clinical evidence, help develop evidence-based coverage policies and medical necessity guidelines, and collaborate with CMS and other Medicare stakeholders.This is an excellent opportunity for a physician with Medicare, payer, utilization review, medical policy, or claims experience who is interested in influencing healthcare policy at a broader level.Key ResponsibilitiesServe as a clinical subject matter expert supporting the Medicare programEvaluate clinical evidence and scientific literature to support evidence-based coverage and medical necessity decisionsParticipate in the development, revision, education, and retirement of Local Coverage Determinations (LCDs)Apply Medicare regulations, National Coverage Determinations (NCDs), LCDs, and clinical guidelinesCollaborate with CMS, Medicare contractors, medical societies, providers, and other healthcare stakeholdersProvide clinical consultation to medical review and appeals teamsOversee complex pre- and post-payment medical review determinationsReview complex appeals and provide guidance regarding Medicare policySupport quality assurance and consistency across clinical review decisionsIdentify trends involving utilization, billing, coding, and potential noncomplianceEducate physicians, providers, and other stakeholders regarding medical policy and Medicare requirementsRepresent the organization in meetings, conferences, and stakeholder discussionsRequired QualificationsMD or DO from an accredited medical schoolCurrent, active, unrestricted U.S. medical licenseBoard certification in an ABMS-recognized specialty for at least three yearsMinimum of three years of clinical practice experience as an attending physicianExpertise in Molecular PathologyStrong knowledge of the Medicare program, particularly coverage and payment requirementsExperience within health insurance, utilization review, healthcare claims processing, medical policy, or a related environmentExperience evaluating clinical evidence and developing or applying coverage, medical necessity, or clinical guidelinesAbility to communicate complex clinical and policy information to both clinical and non-clinical audiencesPreferred QualificationsPrevious Medical Director experience within Medicare, commercial insurance, or another healthcare organizationExperience with LCD/NCD development or applicationExperience with medical review, utilization management, claims, or appealsKnowledge of HCPCS, CPT, and ICD-10 codingExperience with GRADE methodology or systematic literature reviewsExperience working with physician groups, medical societies, government agencies, or other healthcare stakeholdersFive or more years of clinical practice experienceMBA, MHA, MS in Management, or related advanced educationAdditional InformationRemote positionTravel approximately 3–4 weeks annually, depending on business needsThis position offers the opportunity for an experienced physician to combine clinical expertise with Medicare policy and evidence-based coverage decision-making on a national scale.Ascendo is a certified minority-owned staffing firm and an Equal Opportunity Employer.EOCAscendo 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