Medical Director National Government Services
Location: Philadelphia, Pennsylvania
Description: The Graymore Group is hiring Medical Director National Government Services right now, this job will be placed in Pennsylvania. Further informations about this job opportunity please read the description below. A major national health insurance company is seeking a Medical Director of National Government Services NGS This position ’s primary responsibility is to ! actively participate in the Administrative Law Judge ALJ hearings and improve future review and appeal strategies Also responsible for the administration of medical services for company health plans and ensures clinical integrity of broad and significant clinical programs including the overall medical policies of the NGS business unit
This position can be based in any of the following States: DC Maryland New York Virginia Pennsylvania Texas Indiana Kentucky
Primary duties include but are not limited to:
Responsible for all issues that pertain to Medical care as it is delivered to the Medicare beneficiary and as it is billed to NGS a Medicare contractor
Interprets existing policies and develops new policies based on changes in the healthcare or medical arena
Attends Administrative Law Judge hearing to defend position and explain Local Coverage Decisions LCDs and National Coverage Decisions NCDs
Participates in Lo! cal Coverage Determination and Policy Articles development and! revisions
Leads develops directs and implements clinical and non clinical activities that impact health care quality cost and
outcomes
Supports and assists review nurses and the Medical Management staff with Medical Reviews ensuring timely and consistent responses to members and providers
Identifies and develops opportunities for innovation to increase effectiveness and quality
Assist education department with their development of guidelines for providers who participate in the Medicare program
Maintains open lines of communication with CMS and serves as a resource and consultant to other areas of the company
May chair or serve on company committees
A robust salary bonus and benefits package is offered with this position Relocation support is also available
Must hold a current MD degree
Requires board certification where applicable to the duties being performed
10 years of ex! perience with extensive managed care or Medicare knowledge or any combination of education and experience which would provide an equivalent background
Excellent verbal and written communication skills
Travel 5 10 should be expected
- .
If you were eligible to this job, please send us your resume, with salary requirements and a resume to The Graymore Group.
Interested on this job, just click on the Apply button, you will be redirected to the official website
This job will be opened on: Mon, 28 Oct 2013 00:32:40 GMT
Apply Medical Director National Government Services Here