Medical Director, Medicare and Special Investigations Unit

2 days ago


Somerville, Massachusetts, United States Mass General Brigham Full time
Job Title: Medical Director, Medicare and Special Investigations Unit

Mass General Brigham Health Plan is seeking a highly skilled Medical Director to lead our Medicare and Special Investigations Unit. As a key member of our leadership team, you will be responsible for providing clinical oversight and leadership for our Medicare Advantage line of business.

Key Responsibilities:
  • Provide expert medical advice and guidance on Medicare-related activities
  • Lead the Medicare Advantage Utilization Management Committee and ensure compliance with CMS requirements
  • Develop and implement strategies to ensure appropriate, cost-effective, and efficient care for Medicare Advantage and other lines of business
  • Act as physician leader for the Plan's quality management functions, analyzing data to develop interventions that improve quality of care and outcomes
  • Provide expert consultation on Medicare Advantage compliance activities, including audit activities and lead clinical oversight of delegated entities
Requirements:
  • Medical Doctor degree with board eligibility in internal medicine or family practice
  • 5 years of clinical practice experience, including care of patients over 65
  • 2 years of medical management or comparable policy/utilization review experience
  • Valid unrestricted Massachusetts Medical Doctor license
  • Deep understanding of healthcare systems, providers, health insurance drivers, and insurance billing and coding standards
What We Offer:
  • Competitive salary and benefits package
  • Flexible work options and career growth opportunities
  • Collaborative and inclusive work environment

Join our team and contribute to the success of Mass General Brigham Health Plan. Apply today to become our Medical Director, Medicare and Special Investigations Unit



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