Medical Director
ARC Group
Jacksonville, FL
MEDICAL DIRECTOR - REMOTE
ARC Group has an immediate opportunity for a Medical Director! This position is 100% remote working eastern time zone business hours. This is a direct hire FTE position and a fantastic opportunity to join a well-respected organization and have a positive impact on the lives of millions of people. At ARC Group, we are committed to fostering a diverse and inclusive workplace where everyone feels valued and respected. We believe that diverse perspectives lead to better innovation and problem-solving. As an organization, we embrace diversity in all its forms and encourage individuals from underrepresented groups to apply. 100% REMOTE!Candidates must currently have PERMANENT US work authorization. Sorry, but we are not considering any candidates from outside companies for this position (no C2C, 3 rd party / brokering). SUMMARY STATEMENT
The Medicare Contractor Medical Director (CMD) provides medical leadership and decision making for an organization that serves as a Medicare Administrative Contractor (MAC). This role serves as a liaison between the Centers for Medicare and Medicaid Services (CMS) and stakeholders. CMDs play a vital role in developing Local Coverage Determinations (LCDs) and ensuring compliance with Medicare policies, reviewing medical claims, and promoting evidence-based healthcare. ESSENTIAL DUTIES & RESPONSIBILITIES Clinical Expertise and Consultation 30%
ARC Group has an immediate opportunity for a Medical Director! This position is 100% remote working eastern time zone business hours. This is a direct hire FTE position and a fantastic opportunity to join a well-respected organization and have a positive impact on the lives of millions of people. At ARC Group, we are committed to fostering a diverse and inclusive workplace where everyone feels valued and respected. We believe that diverse perspectives lead to better innovation and problem-solving. As an organization, we embrace diversity in all its forms and encourage individuals from underrepresented groups to apply. 100% REMOTE!Candidates must currently have PERMANENT US work authorization. Sorry, but we are not considering any candidates from outside companies for this position (no C2C, 3 rd party / brokering). SUMMARY STATEMENT
The Medicare Contractor Medical Director (CMD) provides medical leadership and decision making for an organization that serves as a Medicare Administrative Contractor (MAC). This role serves as a liaison between the Centers for Medicare and Medicaid Services (CMS) and stakeholders. CMDs play a vital role in developing Local Coverage Determinations (LCDs) and ensuring compliance with Medicare policies, reviewing medical claims, and promoting evidence-based healthcare. ESSENTIAL DUTIES & RESPONSIBILITIES Clinical Expertise and Consultation 30%
- Provide leadership in clinical program outreach to the practitioner/provider/supplier/beneficiary community.
- Provide direction and assistance to clinical staff in conducting provider education, as well as assist in the development of clinical guidelines as needed.
- Keep clinical knowledge up to date and abreast of medical practice and technology changes.
- Serve as a subject matter expert in medical and clinical areas relevant to the Medicare program.
- Provide clinical consultation to internal teams (e.g., medical review staff, appeals teams) and external stakeholders.
- Provide the clinical expertise, scientific literature analysis, claims data analytics to effectively focus medical polical policy and reviews on identified problem areas.
- Collaborate with CMS and other Medicare Contractors (e.g., A/B or DME MACs and others) to develop and update medical policies and articles based on clinical evidence and regulatory requirements.
- Work with multidisciplinary teams within the MAC to improve processes and ensure compliance with CMS directives.
- Liaise with CMS staff, medical societies, and other stakeholders to align goals and address emerging issues.
- Represent the MAC at CMS meetings and industry conferences.
- Strengthen the quality improvement procedures with emphasis on decision consistency and clinical education of clinical staff through various mechanisms including but not limited to overseeing Inter-Reviewer Reliability (IRR) reviews.
- Support program integrity initiatives, including identifying trends in inappropriate billing practices or noncompliance.
- Ensure the proper application of Medicare regulations, national and local coverage determinations (NCDs and LCDs), and clinical guidelines.
- Participate in all phases of LCD development by leading the Local Coverage Determination (LCD) process to include development, revision, retirement, education, and decision making.
- Collaborate with investigative teams and law enforcement when required.
- Oversee medical review activities to ensure appropriate and consistent decisions on claim determinations including pre- and post-payment determinations.
- Provide leadership in developing and implementing MR Quality Assurance Programs.
- Provide leadership in effectively focusing MR and developing internal MR guidelines.
- Review complex or high-level appeals and provide guidance on the application of Medicare policies.
- Provide support to the claim appeal process including assistance in the development of position papers and participation in the administrative process when needed such as Administrative Law Judge (ALJ) hearings.
- Provide leadership in the provider community (including interacting with hospital/specialty associations).
- Educate providers, individually or as a group, regarding identified problems or medical policy.
- Maintain Professional and Organization Relationships
Performs other duties as the supervisor may, from time to time, deem necessary. - Travel within and outside the assigned jurisdictions, as needed. Expected to be no more than 3-4 weeks/year but could vary based on business needs.
- MD or DO degree from accredited Medical School
- Minimum of three years clinical practice experience as an attending physician
- Extensive knowledge of the Medicare program, particularly the coverage and payment rules
- Work experience in the health insurance industry, a utilization review firm, or another health care claims processing organization in a role that involved developing coverage or medical necessity policies and guidelines.
- Knowledge, skill, and experience to evaluate clinical evidence, and to develop evidence-based medical necessity standards within the Medicare fee-for-service benefit structure
- Ability to develop strategies and processes to ensure evidence-based decision-making for policy in the Medicare population
- Basic understanding of medical coding conventions
- Ability to effectively communicate, collaborate with, and provide education on health care policy issues to both internal team members and external entities
- Ability to work collaboratively with internal staff to evaluate aberrancies, determine appropriate billing, coding, pricing, and utilization of services
- Proficiency with effective public speaking and ability educate providers
- Ability to work collaboratively with clinical and non-clinical team members
- Ability and desire to educate team members and external entities (i.e., CMS, providers, other federal agencies, law enforcement, etc.)
- Computer literacy, including proficiency using word processing, spreadsheets, presentation, and virtual meeting applications
- Ability to complete independent or computer-based training and education
Certifications, Licenses, Registration: - Current, active, valid, unrestricted license to practice medicine in at least one state or territory within the United States, never suspended or revoked in any state or territory of the United States
- Eligible for licensure within jurisdiction of enterprise operations
- Board Certified Doctor of Medicine or a Doctor of Osteopathy in a specialty recognized by the American Board of Medical Specialties for at least three years
- Experienced Physical Medicine and Rehabilitation (PM&R), Oncology, Radiology, Ophthalmology or Infectious Diseases professionals with five years of clinical practice
- MBA, MHA, MS in Management, or formal accredited coursework in medical systems management
- Demonstrated successful working experience in organized medicine group(s) (e.g., AMA, specialty society, state health department) as a committee chairperson or other leadership
- Medical Director experience in Medicare-related or commercial healthcare organization
- Coding and billing experience utilizing HCPCs, CPT, and ICD-10 codes
- Experience using GRADE methodology for literature analysis and performing systematic reviews
- Experience working with physician groups, beneficiary organizations, and/or congressional offices
Posted 2025-11-06
Recommended Jobs
Senior DevOps Engineer, Infrastructure & Reliability
Worth Ai
Orlando, FL
Worth AI, a leader in the computer software industry, is looking for a Senior DevOps Engineer to join our Infrastructure team with a singular mission: to make our systems faster, more reliable, and m…
View Details
Posted 2026-02-19
Kia Sales Consultant - New/Used Vehicles
Kia and CDJRF of Fort Myers
Fort Myers, FL
Kia of Fort Myers is Fort Myers’ premier auto dealer. Come and join the hottest franchise in America. We’re growing rapidly and looking to add motivated, career-minded professionals to our team. If…
View Details
Posted 2026-02-27
Interior Designer I
Johns Hopkins Medicine
Saint Petersburg, FL
POSITION SUMMARY: Plans, designs, prepares interior design construction documents relating to additions, alterations and renovations. Reviews performance of existing materials and provides direct…
View Details
Posted 2026-02-20
Low Voltage Service Technician
MCS of Tampa
Tampa, FL
Mission Critical Solutions (MCS) is a leading-edge technology solutions provider, headquartered in Tampa, Florida. MCS provides a broad range of Technology products and services organized in six core…
View Details
Posted 2026-01-27
Transportation Operations Manager
Amazon
Lakeland, FL
Description At Amazon, we are working to be the most customer-centric company on earth. To get there, we need exceptionally talented, bright, and driven people. Amazon is seeking Transportation Op…
View Details
Posted 2026-02-14
SAP- Senior Industry Account Executive (Miami)
SAP
Miami, FL
We help the world run better At SAP, we keep it simple: you bring your best to us, and we'll bring out the best in you. We're builders touching over 20 industries and 80% of global commerce, and w…
View Details
Posted 2026-02-26
Entry Level Pastry Cook
Bern's Steak House
Tampa, FL
Summary Bern's Steak House is looking for someone responsible to create high quality pastry dishes with the standard recipes and presentations of Bern's Steak House in order to maintain quality s…
View Details
Posted 2026-01-29
Plant Mechanic, Property Operations - Signia by Hilton and Waldorf Astoria Orlando
Hilton
Orlando, FL
Signia by Hilton Orlando and the adjacent, Waldorf Astoria Orlando, 2Official Walt Disney World ® Hotels are searching for a PM Plant Mechanic to join their Property Operations team! Between the 2 pr…
View Details
Posted 2026-02-06
Office Manager
premisehealth
Orlando, FL
We have an opening for a Full-Time Office Manager to work at our employer health center located in Orlando, FL! Premise Health is a leading worksite health and patient engagement company dedicated t…
View Details
Posted 2025-08-23
Data Entry Processing Coordinator
QBMS LLC
Fort Lauderdale, FL
: Benefits/Perks Competitive Compensation Paid Time Off Career Growth Opportunities Job Summary Data Entry Processing Coordinators perform data entry, interact with non-US citizen, and…
View Details
Posted 2026-02-26