Remote New

Supv Medical Policy - Novitas (RN) - Remote, FL

Novitas Solutions, Inc.
paid time off, sick time, 401(k), remote work
United States, Florida
Feb 13, 2026
Location United States of America-USAUS Job Description Are you interested in joining a team of experienced healthcare experts and have the ability to shape and transform the healthcare delivery system? At our family of companies, everything we do is to help improve the lives of the nearly 12 million Medicare beneficiaries we serve and 700,000 health care providers who care for them. It is our goal to help create a better health experience for all consumers. Join our winning culture and help transform Medicare for the millions of people who rely on its services. Benefits info: * Medical, dental, vision, life and supplemental insurance plans effective the first day of the month following date of hire * Short- and long-term disability benefits * 401(k) plan with company match and immediate vesting * Free telehealth benefits * Free gym memberships * Employee Incentive Plan * Employee Assistance Program * Rewards and Recognition Programs * Paid Time Off and Paid Sick Leave SUMMARY STATEMENT Serves as department supervisor and project lead for the Local Coverage Determination (LCD) and Local Coverage Article (Article) development and maintenance function for assigned company. This includes varied and highly visible requirements of the company's current CMS contracts. ESSENTIAL DUTIES & RESPONSIBILITIES To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. This list of essential job functions is not exhaustive and may be supplemented as necessary. Oversees and supervises the related LCD processes such as annual and other mandatory updates (e.g., ICD-9-CM, annual reviews, Current Procedural Terminology (CPT) /Healthcare Common Procedure Coding System (HCPCS updates, Change Request updates, etc.). (40 %) * Ensures LCDs are accurate and updated in a timely manner, based on national coding guideline changes and CMS requirements. * Solicits and incorporates feedback and input from CMDs as needed relative to such changes. Oversees and supervises the policy team responsible for the LCD and Article development function which includes the following tasks (15%): * Identify and refine list of potential new LCD topics and revisions to existing LCDs based on ever-evolving medical standards, new technology, new drug development and data analysis. * Directs the Medical Policy Team relative to timelines and deliverables relative to LCD development and revisions, Contractor Advisory Committee (CAC) meeting cycles and CMS requirements. * Ensures timely completion and delivery of LCD "product" to internal and external stakeholders. Oversees and supervises the team responsible for the timely and accurate preparation for posting and maintenance of LCDs and Articles on the company website, and separately but identically on the Centers for Medicare and Medicaid Services (CMS) national Medicare Coverage Database (MCD) in accordance with the CMS regulatory guidance and requirements. (15%) Interfaces with both technical and professional clinical personnel; routinely interacts with all levels of staff within the company as well as entities from other MACs. (10%) * Gains clinical understanding and impacts of LCDs from Contractor Medical Directors (CMDs) (internal) and other MAC's CMDs (external). * Shares LCD impacts with operational areas. * Educates internal team members on system and processing changes resulting from operationalizing LCDs. Maintains regular and ongoing communication with external customers and professionals external to the company (e.g., state Medical Societies, other professional societies or organizations, Medicare providers, CMS, and CAC members) to ensure adequate information sharing/education. (5%) * Works with Provider Outreach and Education (POE) to develop proactive communication and education regarding new and revised LCDs. * Supervises the team that responds to inquiries from providers and other external entities regarding LCDs. Maintains regular and ongoing communications with internal customers regarding LCD and Article activities to ensure adequate information sharing/education as appropriate throughout the company. (5%) * Provides updates to internal and external stakeholders regarding LCD status. * Provides education to internal stakeholders regarding LCD impact and ensures staff understanding of system and processing implications. Oversees and supervises the team that is responsible for the department's preparation for the CAC meetings which includes the following tasks: (5%) * Ensures the coordination of CAC meeting logistics with internal (e.g., POE, contract administration) and external parties (e.g., vendors, hosts, etc.), to include items such as venue, accommodation and technology. * Ensures timely delivery of CAC materials to all physician members of CAC committee. * Attends CAC meetings to support CMDs and Medical Affairs Manager. Assists manager in project management responsibilities, including preparation of workload, budget, and other reporting related to LCDs and Articles. (5%) * Supports management with monthly workload reporting, budgeting and other administrative tasks as assigned. Performs other duties as the supervisor may, from time to time, deem necessary. REQUIRED QUALIFICATIONS * High School Diploma or GED * 3 years' related work experience in clinical field (e.g., Registered Nurse, Physician's Assistant or Physical Therapist), experience in Health or Business Administration, Medicare, health insurance experience in operations, claims review, case review, education, and/or medical and payment policy, and health insurance coding (e.g., ICD-9-CM, CPT/HCPCS). * 2 years' direct supervisory/project management lead or other leadership experience. * Proficient in research of the CMS Internet-Only manual (IOM) and national and local coverage decisions * Comprehensive knowledge of medical, surgical and diagnostic procedures and terminology * Proficient in MS Office applications and Internet research * Excellent written and oral communication skills * Ability to communicate with confidence with other medical professionals, Medical Societies, Medicare providers, CMS and Contractor Advisory Committee (CAC) members * Professional demeanor and positive approach to work * Excellent planning, organizing, time and work management skills * Active and current medical professional licensure - Registered Nurse (RN) license PREFERRED QUALIFICATIONS * Direct supervisory experience* 5+ years' related work experience * Certified Professional Coder (CPC) credential Requirements The Federal Government and the Centers for Medicare & Medicaid Services (CMS) may require applicants to have lived in the United States for a minimum of three (3) years out of the last five (5) years to be employed with the Company. These years of residence do not have to be consecutive. Background Investigation: If you are selected for this position, you must undergo a pre-employment Background Investigation, Drug Screen, and Identity Proofing documentation must be cleared prior to hire. Most positions are subject to additional Identity Proofing, Fingerprinting and additional Background Investigation screening conducted by the Federal Government to be granted Enterprise User Administration (EUA) system logical access after you begin your employment. Your continued employment is contingent upon the outcome of the complete additional screening criteria required for the position which must find that you meet the applicable government customer's requirements (e.g., suitable for access to CMS information and information systems), as well as any additional investigation which may be required throughout your employment. If you are found not suitable, your employment may be subject to corrective action, up to and including immediate termination of employment. Identity Documentation: You must have access to a current and unrestricted REAL ID, U.S. Passport, U.S. Passport Card, Foreign Passport, or U.S. Permanent Residency Documents. Note: Employment Authorization Cards (EAD) are not a substitute for Visas or U.S. Permanent Resident Cards. "We are an Equal Opportunity/Protected Veteran/Disabled Employer." This opportunity is open to remote work in the following approved states: AL, AR, FL, GA, ID, IN, IO, KS, KY, LA, MS, NE, NC, ND, OH, PA, SC, TN, TX, UT, WV, WI, WY. Specific counties and cities within these states may require further approval. In FL and PA in-office and hybrid work may also be available.