Senior Medical Director – Precertification

Job Description

Seeking a Senior Medical Director to provide strategic direction and leadership for our precertification process and clinical operations. Collaborate with executive leadership to develop and implement healthcare strategies, improve processes, and drive innovation. Leverage expertise to align company goals with clinical strategies and regulatory requirements. Establish clinical standards, oversee governance structures, and lead the development of clinical processes and programs. Manage the Medicare Precertification MD Team, ensure audit readiness, and stay updated on industry standards. Mentor physicians, foster a cohesive team, and ensure compliance with regulatory requirements.

Qualifications

1. MD or DO with active, unrestricted license and board certification in an ABMS or AOA recognized specialty 2. Minimum 5 years of direct patient care in a clinical setting 3. Minimum 5 years in utilization management, precertification, or related roles 4. Deep expertise in Medicare regulations, including NCDs, LCDs, Medicare manuals, and regulatory references 5. Proven ability to interpret and apply Medicare guidelines to complex case review and decision-making 6. Advanced knowledge of medical coding standards, compliance requirements, and oversight of coding practices 7. Demonstrated leadership in managing teams, driving process improvement, and ensuring regulatory compliance 8. Successful track record guiding teams through Medicare audits and maintaining audit readiness 9. Strong interpersonal, communication, and cross-functional stakeholder management skills 10. Commitment to developing talent and fostering an inclusive, high-performing team culture

Benefits

- Medical, dental, and vision coverage - Paid time off - Retirement savings options - Wellness programs - Other resources, based on eligibility