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Medical Director (Remote Work)

Company: WPS Health Solutions
Location: Dallas
Posted on: May 24, 2020

Job Description:

Role Summary:

The Medical Director is a physician leader with expert knowledge in Medicare appeals and regulations. The Medical Director is responsible for clinical coverage determinations and staff training on clinical matters and collaborating with medical societies and peer groups to share information and provide education.

In this role you will:

  • Work with RN(s) on local coverage determinations- reviewing new procedures that may involve new technology and determine if they believe Medicare program should cover
  • Organize and facilitate Contractor Advisory Committee meetings (CAC) including, meeting and recruiting CAC members
  • Work with Medical Review Clinical Team to help develop our Medical Review strategies
  • Work with data analytics team to request data that they can analyze in an effort to determine if we have some aberrancy with a particular service or provider
  • Ensure we are meeting clinical aspects of contracts
  • Meet with CMS staff to provide updates
  • Involved in responding to requests for proposals both new and existing contracts
  • Respond to inquiries from providers and representatives of the medical industry regarding advanced medical solutions that may provide better patient treatments
  • Provide consultation to law enforcement with investigations regarding fraudulent provider activity

    This role could be a good fit if you:

    • Enjoy having the ability to influence the delivery of health care
    • Enjoy working in a team environment, while being remote
    • Use your medical training in a new way
    • Would welcome no weekends, holidays, swing shifts, WORK LIFE BALANCE

      You'll benefit from this experience by:

      • Working with CMS- the single largest payer for healthcare in the U.S.
      • Having the ability to make recommendations on how to make sure health care is delivered in the most effective way
      • Having the opportunity to work outside your specialty - Ability for continuous learning

        You need to have:

        • 5 or more years experience practicing physician, with experience in Medicare insurance policies and regulations
        • One of the following credentials: MD or DO
        • Board Certified in a Medical Specialty
        • Valid medical license (in any state) with no federal sanctions
        • Ability to travel 20-25%

          Compensation and Benefits

          • Eligible for annual Performance Bonus Program
          • 401(k) withdollar-per-dollar match up to6% of salary
          • Competitive paid time off
          • Health and dental insurance startDAY 1
          • Vision insurance
          • Flexible spending, dependent care, and health savings accounts
          • Short- and long-term disability, group life insurance
          • Dress for your day
          • Innovative professional and cognitive development programs

            Who We Are

            WPS Health Solutions is an innovator in health insurance and a worldwide leader in claims administration, serving millions of beneficiaries in the United States and abroad.

            Founded in 1946, WPS offers health insurance plans for individuals, families, and seniors, and group plans for small and large businesses. We are a world-class claims processor and program administrator for the government's Medicare program. And we manage benefits for millions of active-duty and retired military personnel and their families.

            WPS has been named one of theWorld's Most Ethical Companies-- by the Ethisphere-- Institute for 10 years in a row.

            Learn more about WPS.

            Our Purpose and Values

            Our purpose is to make healthcare easier for those we serve.Click Here

            Our values- Customer Focused, Individual Responsibility, Mutual Respect, and Driven& Passionate- are the core of who we are and how we conduct business every day.

            Links and descriptions for:


            WPS Health Insurance offers high-quality health insurance plans for individuals and families, Medicare supplement plans for seniors, and group health plans for businesses of every size.



            WPS Military and Veterans Health administers claims and provides customer service and related activities for the U.S. Department of Defense and the U.S. Department of Veterans Affairs and their beneficiaries.



            WPS Government Health Administrators manages Medicare Part A and Part B benefits for more than 7 million beneficiaries. As one of the largest contractors for the Centers for Medicare& Medicare Services, we've served Medicare beneficiaries and their health care providers since 1966.



            Arise Health Plan provides innovative and high-value health plans to groups and individuals in eastern and northeastern Wisconsin. With our quality Wisconsin-based customer service, Arise offers health care expertise with a personal touch.



            EPIC Specialty Benefits provides businesses group insurance products that cover:

            • Life
            • Disability
            • Dental
            • Vision
            • Voluntary benefits


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Keywords: WPS Health Solutions, Dallas , Medical Director (Remote Work), Executive , Dallas, Texas

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