Chief Medical Officer – Medicare Policy

CGS Administrators, LLC

Chief Medical Officer responsible for case review and regulatory matters at BlueCross BlueShield. Developing medical policies and leading initiatives within the organization.

Posted 6/11/2026full-timeRemote • Tennessee • 🇺🇸 United StatesLeadWebsite

About the role

Key responsibilities & impact

Supports operations in the form of case review on both medical and regulatory matters.
Develops claim adjudication criteria for situations requiring medical judgment.
Provides input on issues and operational policies, processes, and procedures.
Educates staff and medical community on various aspects of medical policy and program administration.
May develop and update medical policy in consultation with appropriate regulatory personnel, medical consultants, and professional societies.
Develops external relationships with the medical community and serves as liaison between these entities and the contractors.
Reviews physician and provider practice pattern analysis and other statistical data related to unusual medical service utilization.
Conducts research into new or controversial medical procedures and technology.

Requirements

What you’ll need

Doctorate in a job-related field
Active state medical license and current board certification in a recognized specialty.
5 years post graduate experience in direct patient care.
Excellent verbal and written communication skills.
Excellent customer service, organizational, and presentation skills.
Good judgment skills.
Proficiency in spelling, punctuation, and grammar.
Ability to persuade, negotiate, or influence others.
Ability to work as a team member as well as a leader.
Knowledge of medical and utilization review techniques.
Microsoft Office proficiency

Benefits

Comp & perks

Subsidized health plans, dental and vision coverage
401k retirement savings plan with company match
Life Insurance
Paid Time Off (PTO)
On-site cafeterias and fitness centers in major locations
Education Assistance
Service Recognition
National discounts to movies, theaters, zoos, theme parks and more

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

claim adjudication criteriamedical judgmentmedical policy developmentmedical procedure researchutilization review techniques

Soft Skills

verbal communicationwritten communicationcustomer serviceorganizational skillspresentation skillsjudgment skillspersuasionnegotiationteamworkleadership

Certifications

active state medical licenseboard certification