Job Title:Medical Director Sr Principal Leader
Job Number:0900AYG

Job Category:Health Care
Primary Location:USA-VA: VIRGINIA-RICHMOND
Schedule:Full-time
Job Type:Regular
Employee Status:Regular
Travel:Yes, 25% of the time
Job Posting:2009-Nov-02
Description
Essential Job Functions

• Provides medical expertise in all Medicare claim types to ensure that medical review of claims and related processes follow protocol and are accurate.
• Recognizes, evaluates, interprets, recommends and implements policies and procedures for all components of medical review and CERT improper payment report production and meets deadlines, assignments, and objectives. Prepares periodic reports regarding activities and goal attainment progress.
• Provides input and medical expertise to AdvanceMed programs.
• Participates in AdvanceMed communicates on an ongoing basis with senior management to insure program effectiveness. Recommends improvements to established procedures and oversees implementation of changes to ensure uniformity of implementation.
• Provides assistance and advice to Program Director on as needed basis for issues related to Medical Review or that require physician input.
• Trains and evaluates nurse reviewers on medical review topics to enhance their performance, development, and work product.
• Prepares and recommends ad hoc reports related to Medical review of sources of improper payments upon request from the Program Director or the CERT GTL.
• Provides leadership and work guidance to less experienced personnel.

• Medical degree or equivalent combination of education and experience
• Medical degree in a related field preferred
• Eleven or more years of medical experience
• Experience working with various Medicare Medical Review areas
• Experience working with compliance related policies, procedures, guidelines, and laws related to Medicare Coverage and Regulations.
• Experience working with Medicare Claims review practices and procedures
• Experience working with generally accepted Microsoft software and data analysis software available to AdvanceMed
• Board certification preferred

• Strong communication skills
  
• Strong interpersonal and presentation skills for interacting with team members and clients
  
• Strong analytical and problem solving skills
  
• Strong organization and time management skills
  
• Leadership skills to guide and mentor the work of less experienced personnel
  
• Ability to keep sensitive and confidential material private
  
• Ability to lead in a team environment
  
• Ability to handle multiple tasks and switch between tasks quickly
  
• Willingness to travel