Medical Director (MD/DO)
Location: Jacksonville, FL
Job Type: Direct Placement
Company: ARC Group
Category: Administration
Job Description Apply Now
The Medical Director (MD/DO) position offers a unique opportunity to provide clinical leadership and make a significant impact within a respected healthcare organization. This full-time, remote role enables the Medical Director (MD/DO) to work Eastern Time Zone business hours and collaborate with a diverse and mission-driven team. As the organization serves as a Medicare Administrative Contractor (MAC), the Medical Director (MD/DO) plays a vital role in bridging the gap between the Centers for Medicare and Medicaid Services (CMS) and key stakeholders, ensuring compliance with Medicare policies and promoting evidence-based healthcare delivery across millions of beneficiaries and thousands of providers.
The Medical Director (MD/DO) is responsible for leading local coverage determination (LCD) initiatives, reviewing complex medical claims, overseeing appeals, and contributing to program integrity efforts. This role requires a blend of clinical expertise, strong leadership, and the ability to communicate effectively with both internal and external partners, including CMS staff, medical societies, and provider networks. The Medical Director (MD/DO) also provides critical input into the development of clinical guidelines, ensures consistency in decision-making, and leads educational outreach efforts aimed at improving healthcare quality and regulatory compliance.
Joining this organization as Medical Director (MD/DO) means working for a group that values diversity, equity, and inclusion. The company's commitment to creating a welcoming and supportive environment is reflected in its dedication to fostering innovation, respecting all perspectives, and encouraging applications from underrepresented groups. Employees benefit from a culture of integrity, continuous learning, and collaboration, with ample opportunities to advance their careers while contributing to the organization's mission to deliver high-quality, compliant healthcare solutions.
The Medical Director (MD/DO) position is ideally suited for an experienced physician who thrives in a collaborative, regulatory-focused healthcare environment and who is passionate about advancing the quality and effectiveness of healthcare programs. By joining the team, the Medical Director (MD/DO) will contribute to shaping policy, streamlining processes, and ensuring patient care aligns with current clinical evidence and regulatory requirements.
If you are seeking a challenging and rewarding career as a Medical Director (MD/DO) and wish to make a positive impact on the healthcare community, we invite you to apply by clicking the job application button today.
Medical Director (MD/DO) - Summary- Remote, full-time opportunity providing clinical and policy leadership for a Medicare Administrative Contractor (MAC).
- Serves as a liaison between CMS and stakeholder communities, developing and enforcing Medicare policy and local coverage determinations.
- Focuses on compliance, program integrity, provider education, and quality improvement processes.
- Offers an inclusive, mission-driven workplace culture with a focus on diversity and professional growth.
- Provide clinical leadership in developing and updating local coverage determinations (LCDs) and ensuring compliance with Medicare regulations.
- Offer consultation and subject matter expertise to internal teams and external partners regarding Medicare policies and clinical guidelines.
- Lead outreach and education initiatives to provider communities, supporting evidence-based practice and regulatory compliance.
- Collaborate with CMS, other Medicare contractors, and multidisciplinary teams to address emerging clinical and policy issues.
- Support program integrity by identifying and addressing inappropriate billing practices and ensuring adherence to national and local coverage determinations.
- Oversee medical review (MR) and appeals processes, including complex case review and participation in administrative hearings when necessary.
- Travel as needed for provider education, conferences, and stakeholder meetings (typically 3-4 weeks per year, subject to business needs).
- Competitive compensation package aligned with experience and qualifications.
- Comprehensive benefits typically include health insurance, retirement plans, paid time off, and professional development opportunities.
- Remote/work-from-home flexibility with supportive organizational culture.
- MD or DO degree from an accredited medical school.
- Minimum of three years’ clinical practice experience as an attending physician, preferably in Physical Medicine and Rehabilitation (PM&R).
- Extensive knowledge of Medicare program rules, including coverage and payment policies.
- Experience in the health insurance industry, utilization review, or healthcare claims processing involving policy development.
- Demonstrated ability to evaluate clinical evidence and develop evidence-based medical necessity standards.
- Basic understanding of medical coding conventions.
- Excellent communication, collaboration, and education skills.
- Proficiency in computer applications including word processing, spreadsheets, presentations, and virtual meetings.
- Current, active, unrestricted license to practice medicine in at least one U.S. state or territory.
- Board certification in a medical specialty recognized by the American Board of Medical Specialties.
- Physician with strong background in Medicare policy, clinical practice, and healthcare administration.
- Proven leadership in organized medicine or healthcare organizations.
- Advanced degrees or certifications (MBA, MHA, MS in Management) and coding/billing experience preferred.
- Experience with GRADE methodology and systematic literature reviews a plus.
- Demonstrated success educating and collaborating with provider groups and regulatory entities.
- Commitment to fostering a diverse, equitable, and inclusive work environment.
- Applicants must have permanent U.S. work authorization.
- Equal Employment Opportunity (EEO) statement: The organization is committed to providing equal employment opportunities and encourages applications from all qualified individuals regardless of race, ethnicity, religion, gender identity, sexual orientation, age, disability, or protected status. Accommodations available upon request.
- No candidate fees associated with this position.
- Immediate consideration available; click the job application button to apply now.