Medical Director, Medicare Clinical Policy

Molecular Pathology Preferred | Additional Clinical Specialties Considered
Full-time, exempt | Remote
Anticipated base salary: $200,000 to $300,000, plus bonus
Travel: Approximately 3 to 4 weeks annually

About the Opportunity

Our client is a large organization operating within the Medicare Administrative Contractor environment. It supports Medicare Part A and Part B claims administration, appeals, provider education, clinical review, and program integrity across a broad multistate service footprint.

The organization is seeking an experienced physician to apply deep specialty expertise and disciplined evidence evaluation to Medicare clinical policy, medical review, appeals, provider education, and program-integrity decisions.

Molecular pathology remains a priority specialty. The search has also expanded to include qualified physicians in:

• Infectious Disease

• Oncology

• Cardiology

• Surgical Specialties

The strongest candidates will combine credible specialty expertise with the ability to evaluate scientific evidence, reach defensible conclusions about medical necessity, write clearly, and communicate effectively with providers, reviewers, clinical leaders, and government stakeholders.

Prior Medicare, payer, or Local Coverage Determination experience is valued, but it is not required. Accomplished physicians from academic medicine, health systems, federal practice, clinical laboratories, specialty programs, and other provider environments are encouraged to apply when their experience demonstrates strong evidence judgment and a credible connection to policy, utilization, quality, or medical review.

What You Will Do

• Serve as a physician subject-matter expert within your clinical specialty.

• Evaluate peer-reviewed research, clinical guidelines, standards of care, treatment outcomes, emerging technologies, and applicability to the Medicare population.

• Apply a structured methodology to clinical-policy development, including defining the clinical question, assessing evidence quality, reconciling conflicting findings, evaluating benefits and risks, and documenting a clear recommendation.

• Lead or contribute to Local Coverage Determinations, associated billing and coding articles, responses to public comments, clinical guidelines, medical-review positions, and related policy materials.

• Provide physician judgment for complex medical reviews, medical-necessity questions, claims issues, appeals, denial rationale, position papers, and administrative proceedings.

• Analyze utilization, documentation, coding, billing, and claims patterns to identify inappropriate use, improper-payment risk, clinical inconsistencies, and program-integrity concerns.

• Collaborate with clinical, operational, coding, compliance, appeals, informatics, medical-review, and program-integrity teams.

• Engage with CMS, peer Medicare contractors, provider organizations, professional societies, consultants, and external clinical experts as needed.

• Translate complex clinical evidence and Medicare requirements into clear provider education, internal training, presentations, and written guidance.

• Help improve the quality, consistency, and defensibility of physician-review decisions and related clinical processes.

Required Qualifications

• MD, DO, or equivalent physician medical degree. International medical degrees may be considered when U.S. licensure and physician-practice requirements are met.

• Current, active, unrestricted U.S. medical license and the ability to obtain any additional licensure required for the position.

• Relevant physician board certification in one of the accepted specialty areas.

• At least three years of attending-level or equivalent independent physician practice following residency and fellowship training.

• Substantial current or prior clinical expertise in Molecular Pathology, Infectious Disease, Oncology, Cardiology, or a recognized Surgical Specialty.

• Demonstrated ability to evaluate scientific and clinical evidence using a structured, repeatable methodology.

• Ability to translate evidence into clear judgments about clinical utility, medical necessity, appropriate utilization, or standards of care.

• Strong scientific writing, presentation, and verbal communication skills.

• Evidence of leadership, ownership, and cross-functional influence. This may include clinical-program leadership, section or service-line responsibility, committee leadership, guideline development, quality initiatives, research leadership, or ownership of a significant policy or operational initiative.

• Credible exposure to clinical policy, utilization, documentation, quality, medical review, coding, billing, claims, appeals, technology adoption, or payer interaction.

• Interest in transitioning into a primarily non-patient-facing role centered on evidence, policy, review, program integrity, writing, and stakeholder communication.

Specialty Pathways

Molecular Pathology

Relevant backgrounds may include:

• Molecular Genetic Pathology certification

• Accredited Molecular Genetic Pathology fellowship with relevant physician board certification

• Anatomic Pathology, Clinical Pathology, AP/CP, or Clinical Genetics and Genomics certification combined with substantial clinical molecular-diagnostics leadership

• Clinical responsibility for genomic test interpretation, NGS, molecular oncology, biomarkers, germline or somatic testing, assay evaluation, molecular infectious disease, pharmacogenomics, or related diagnostic technologies

Infectious Disease, Oncology, Cardiology, and Surgical Specialties

Candidates should bring:

• Relevant board certification

• Substantial independent specialty practice

• Broad and current clinical authority within the specialty

• Experience applying evidence to guidelines, pathways, appropriateness criteria, medical necessity, quality, utilization, policy, technology assessment, or physician review

• Strong written and verbal communication with clinical and nonclinical stakeholders

A specialty credential alone will not establish fit. The successful physician must be able to demonstrate how they evaluate evidence, make difficult clinical decisions, document their rationale, and defend conclusions to varied audiences.

Preferred Qualifications

• Experience with a Medicare Administrative Contractor, CMS, Original Medicare, Medicare Advantage, a commercial payer, or another government-sponsored health program

• Medical-policy, utilization-management, prior-authorization, physician-review, or health-plan Medical Director experience

• Local or National Coverage Determination development, reconsideration, evidence analysis, response-to-comment work, or Contractor Advisory Committee participation

• Systematic review, GRADE methodology, technology assessment, comparative-effectiveness research, guideline development, or formal evidence-synthesis experience

• Working knowledge of CPT, HCPCS, ICD-10, medical coding, reimbursement, claims analysis, or documentation requirements

• Experience with appeals, peer-to-peer review, administrative hearings, audits, program integrity, improper-payment analysis, or provider education

• Leadership within a professional society, consensus panel, guideline committee, quality organization, coding committee, public-health program, or national clinical initiative

• Advanced training in health policy, epidemiology, informatics, public health, healthcare administration, or management

Role Details

• Employment: Full-time and exempt

• Work model: Remote from an approved U.S. work location

• Priority hiring states: Alabama, Florida, Georgia, Mississippi, North Carolina, South Carolina, and Texas. Pennsylvania may be considered outside Philadelphia. Additional locations may be available following verification.

• Compensation: Anticipated base salary of $200,000 to $300,000, plus bonus. Final compensation will reflect experience, credentials, specialty alignment, and approved work location.

• Travel: Approximately 3 to 4 weeks annually, based on business needs

• Clinical structure: Primarily non-patient-facing, with significant responsibility for evidence review, policy development, medical review, writing, meetings, and stakeholder communication

In the Medicare environment, the term Contractor Medical Director describes a physician leadership role within the Medicare contractor organization. It does not indicate 1099 or independent-contractor employment.

How to Apply

Apply with a current CV or resume that clearly identifies your medical degree, board certifications, licensure, postgraduate training, and independent physician-practice history.

Please do not self-select out solely because you have not worked for a payer, held a formal Medical Director title, managed direct reports, or previously written an LCD. Strong academic and provider-side physicians will be considered when they can demonstrate specialty authority, structured evidence evaluation, clear communication, leadership, and a credible connection to medical policy or review.

This is an opportunity to extend your clinical expertise beyond an individual practice or health system and help shape evidence-based Medicare policy, responsible payment, provider understanding, and consistent medical-review decisions at scale.

Ascendo is a certified minority owned staffing firm, and we welcome and celebrate diversity. Ascendo is an Equal Opportunity Employer and does not discriminate on the basis of race, color, religion, sex (including pregnancy and gender identity), national origin, political affiliation, sexual orientation, marital status, disability, genetic information, age, parental status, military service or any other characteristic protected by federal, state or local law.

Contact information

Christian Kincer