Medical Director - Physiatrist

As a condition of employment physical work location must be in one of the 50 states or the District of Columbia.

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Medical Director - Physiatrist

Requires: Specialty in Physiatry

The Medical Director (MD) assures clinical appropriateness and standard of care for all Medicare Administrative Contractor (MAC) activities and processes, within the boundaries of federal law, Medicare regulation and Centers for Medicare and Medicaid Services (CMS) National Coverage Determinations (NCDs), and Local Coverage Determinations (LCDs).

Prefer that Medical Directors maintain limited clinical practice to remain actively involved in patient care.

• Develops new local contractor determinations (LCDs), complete LCD redeterminations, and participates in LCD challenges as required by contract
• Leads policy team with research and drafting of new or revised LCDs
• Participates in meetings/conferences/panels/forums/hearings with contractors, providers, CMS Committees, law enforcement, or other stakeholders
• Facilitates edits for NCDs as require by contract
• Participates in initiatives to reduce Medicare Fee for Service (FFS) improper payments, as measured by Comprehensive Error Rate Testing (CERT) error rates as required by contract
• Provides guidance and medical advice for product or service-related activities, as required by contract
• Provides input and guidance to Medical Review strategies and determinations and broadly to staff training and coordination as needed
• Provides input, guidance, and participation for appeals, Administrative Law Judge (ALJ) hearings and LCD challenges

• Other duties as assigned

• Doctorate degree in medicine, Medical Doctor (MD) or Doctor of Osteopathy (DO)
• Unrestricted license to practice medicine or osteopathy in any U.S. state or territory, never suspended or revoked in any state or territory
• Certification by an American Board of Medical Specialties upon hire (verification required) and may be required to maintain throughout employment
• 5 years' experience as a Medicare provider with no restrictions, suspensions or revocations
• Working comfort with Microsoft applications: Word, Excel, Outlook, PowerPoint

• Experience as a health plan medical director/Medicare medical director
• 8 years total experience as a Medicare provider with no restrictions, suspensions or revocations
• Formal training in evaluating and critically reviewing medical literature.
• Masters in Public Health
• Maintenance of ABMS certification
• Detailed working knowledge of CMS National Coverage Assessments and Determinations and Medicare and relate federal legislation and regulations
• Working knowledge of appeals processes and requirements, including re-openings, reconsiderations, and Administrative Law Judge hearings with detailed experience and federal court or administrative hearing experience
• Working knowledge of Microsoft Access, SharePoint, and Project

Medical Director I specialties include but are not limited to:

Dentistry, Family Medicine, Gerontology, Pediatrician, Endocrinology, Physiatry and Internal Medicine

Medical Director II specialties include but are not limited to:

Emergency Medicine, Pulmonary, Cardiology, and General Surgeon

• Office Environment
• Ability to read, hear, speak, keyboard, reason, communicate effectively and problem solve
• Requires prolonged sitting and telephone use
• Requires the use of office equipment such as computers, telephones, copiers and printers
• Infrequent lifting to 15 pounds
• Infrequent stooping
• Periodic travel

Every employee is responsible to perform their duties and responsibilities in accordance with Noridian values, policies and procedures, including but not limited to: Segregation of Duties Principles, HIPAA, Security and Privacy, CMS requirements, the Noridian Compliance Program and any other applicable laws, rules and regulations.

This document describes the essential functions, requirements, and responsibilities of this job, and is not intended to be a complete list of all tasks and functions. Employees may be requested to perform job related tasks other than those specifically listed in this description and may be required to perform any task requested by the supervisor or management.

Health, Dental and Vision Insurance, Voluntary Insurance Plans, Health Savings and Flexible Spending Accounts, 401k and Company Match, Company-paid Life Insurance, Education Assistance Program, Paid Sick Leave, Paid Holidays, Increasing PTO Accrual Plan, Medical/Parental/Disability Leave, Workers Compensation, Retiree Benefits, Employee Assistance Program, Financial and Health Wellness Benefits, Casual Dress, Open Office Setting, and Online Learning System.

Some positions require compliance with (i) federal and agency specific regulations and related clauses included in Noridian's prime contracts with the Government, (ii) background checks, and (iii) eligibility for a government-issued identification card.

An employee in this position may be required to possess a "Federal Identification Card" (Federal ID) as a condition of employment. Federal ID's may include one of the following: Personal Identity Verification (PIV) card, Personal Identity Verification-Interoperable (PIV-I) card, a Local-Based Physical Access Card issued by CMS, or a Local-Based Physical Access Card issued by another Federal agency and approved by CMS. Obtaining a Federal ID and continued eligibility for this position may require the successful completion of a Federal Background Investigation performed by the Federal Government and a residency requirement that you have lived in the United States at least three out of the last five years. Failure to obtain a Federal ID may result in the removal from the position or termination of employment.

Equal Employment Opportunity

Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or other characteristics protected by state or federal law.

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information. 41 CFR 60-1.35(c)

Other Compensation: Incentive Plan, Self-Managed PTO & Lifestyle Benefit

This job will be closed 05/14/2026 at 8:00AM CST. No further applications will be considered.