Mgr Medical Affairs-Novitas - Remote, FL

Location:

United States of America-USAUS

Are you interested in joining a team of experienced healthcare experts and have the ability to shape and transform the healthcare delivery system? At our family of companies, everything we do is to help improve the lives of the nearly 12 million Medicare beneficiaries we serve and 700,000 health care providers who care for them. It is our goal to help create a better health experience for all consumers.

Join our winning culture and help transform Medicare for the millions of people who rely on its services.

• Medical, dental, vision, life and supplemental insurance plans effective the first day of the month following date of hire
• Short- and long-term disability benefits
• 401(k) plan with company match and immediate vesting
• Free telehealth benefits
• Free gym memberships
• Employee Incentive Plan
• Employee Assistance Program
• Rewards and Recognition Programs
• Paid Time Off and Paid Sick Leave

This position is responsible for managing/directing the medical affairs team including Research Analysts, Pricing Consultants, Policy Nurses, Business Analysts, Medical Research Consultants, and other specialized personnel in project endeavors related to the development, implementation, operationalizing, and communication/education of local coverage determinations and local contractor pricing. The position is also accountable for handling complex medical policy inquiries and collaborating and supporting the Contractor Medical Directors (CMDs) regarding clinical/medical decision making for both First Coast and Novitas.

These functions are detailed in the section below.

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. This list of essential job functions is not exhaustive and may be supplemented as necessary.

• In conjunction with the CMDs, responsible for all Local Coverage Determinations (LCD) activities which include LCD clinical evidence research to determine validity of evidence, LCD development, internal/external LCD communication and education, LCD analysis for revision or retirement, creation of coverage and billing coding articles relating to LCDs, LCD effectiveness and LCD reconsideration requests.
• Responsible for the timely establishment and implementation of effective LCD edits in the Multi-Carrier System (MCS) and Fiscal Intermediary Shared System (FISS) to operationalize all LCDs to ensure the accurate processing of claims. Ensures education is provided on the LCD and LCD edits to all operational areas (i.e., Claims, Appeals, Medical Review, Prior Authorization, Informatics, etc.).
• Responsible for oversight of stakeholder engagement and transparency regarding LCD and local pricing activities.
• Responsible for the Contractor Advisory Committee, a group of external healthcare professionals who are informed of the evidence used in developing LCDs and who promote communications between First Coast and Novitas and the healthcare community, to include ensuring inclusive membership and scheduling/facilitating all required meetings.
• Responsible for the oversight of scheduling/facilitating all Open meetings which are required by CMS to allow interested external parties the opportunity to make presentations of information and offer comments related to new proposed LCDs.
• Responsible for receiving, assigning, tracking, and ensuring the timely completion of all CMD, medical policy, pricing, coding, and clinical inquiries from operations, stakeholders, CMS, law enforcement, other CMS contractors, etc.
• Responsible for receiving, assigning,…