Clinical Medical Director

LivantaLLC

Clinical Medical Director overseeing clinical reviews within a CMS program. Engaging in ALJ hearings and ensuring consistency in medical determinations and quality assurance.

Posted 7/28/2026full-timeRemote • 🇺🇸 United StatesLead💰 $275,000 - $375,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in Medicare coverage policy, including National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs), while providing clinical oversight and quality assurance in medical review processes. Engages actively in issue resolution and represents the program in ALJ hearings, ensuring defensible clinical determinations.

Highest-signal resume keywords

Doctor Of Medicine (MD)Doctor Of Osteopathic Medicine (DO)Board-Certified In Relevant SpecialtyMedicare Coverage Policy ExpertiseALJ Hearing Representation

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Clinical OversightQuality AssuranceMedical Review ActivitiesUtilization ReviewHealthcare Claims ProcessingMedical Necessity CriteriaCoverage Determination StandardsIssue ResolutionTestimony PreparationClinical Evidence Presentation

Soft Skills

Active EngagementCollaborationCommunication

Tools & Technologies

Internet-Only Manual (IOM 100-8)

Certifications & Qualifications

Active Medical Licensure

Industry Keywords

CMS ProgramNational Coverage Determinations (NCDs)Local Coverage Determinations (LCDs)ALJ HearingsContractor Medical Director Experience

About the role

Key responsibilities & impact

Serve as the final clinical authority for complex, disputed, or escalated medical review determinations across the CMS program.
Represent the program at Administrative Law Judge (ALJ) hearings; testify and defend the clinical basis for review determinations.
Minimum 10 ALJ appearances per month required.
Participate in Discussion and Education (D&E) sessions with providers and their representatives when disputes are escalated to the physician level.
Provide clinical oversight and quality assurance across the medical review function, ensuring determinations are consistent, well-documented, and defensible under Medicare coverage policy.
Actively engage with CMS on issue resolution, medical review policy interpretation, and emerging coverage questions; participate in CMS meetings and work groups as required.
Collaborate with the Project Manager, clinical reviewers, and operational leadership to support program performance, staff education, and continuous quality improvement.
Maintain currency with Medicare coverage policies, National Coverage Determinations (NCDs), Local Coverage Determinations (LCDs), and relevant IOM guidance (including IOM 100-8).

Requirements

What you’ll need

Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO); board-certified in a relevant specialty.
Currently licensed to practice medicine in the United States; licensure must remain active and in good standing throughout employment.
Minimum 3 years of active medical practice experience post-residency.
Background in health insurance, utilization review, or healthcare claims processing, including familiarity with medical necessity criteria and coverage determination standards.
Demonstrated capacity for active, substantive engagement in medical review activities, issue resolution, and CMS-directed meetings — this position requires consistent hands-on participation and is not a nominal or figurehead role.
Prior Contractor Medical Director or Medical Director experience at a CMS review contractor preferred.
In-depth familiarity with Medicare coverage policy, National Coverage Determinations (NCDs), Local Coverage Determinations (LCDs), and Internet-Only Manual guidance, including IOM 100-8 preferred.
Experience participating in or leading ALJ hearing representation in a Medicare appeals context, including preparation of written testimony and presentation of clinical evidence preferred.
Multi-state medical licensure preferred given the nationwide scope of review activities.

Benefits

Comp & perks

🌐 Worldwide ❌ Jobs You've Hidden ⭐️ Saved Jobs ✅ Applied Jobs ✉️ Email Alerts 👤 Account LivantaLLC Website LinkedIn All Job Openings 201 - 500 employees Founded 2004 🏥 Healthcare 💼 Consulting ⚕️ Healthcare Insurance Healthcare
Consulting
Healthcare Insurance Livanta LLC is a technology-enabled organization dedicated to advancing healthcare quality through innovation. It specializes in providing services to patients, caregivers, healthcare providers, and payers, focusing on improving health outcomes, navigating healthcare systems, and ensuring payment accuracy. Livanta is recognized as the largest Medicare Quality Improvement Organization and offers a range of services including quality oversight, auditing, advocacy, and data analytics to enhance patient care and safety while managing healthcare costs effectively. Clinical Medical Director Job not on LinkedIn 🔥 3 minutes ago 🇺🇸 United States – Remote 💵 $275k - $375k / year ⏰ Full Time 🔴 Lead 👨‍⚕️ Medical Director Apply Now Find Hiring Managers Customize resume + cover letter Report problem ☆ Save ☑️ Mark as applied ❌ Hide 📋 Description
Serve as the final clinical authority for complex, disputed, or escalated medical review determinations across the CMS program.
Represent the program at Administrative Law Judge (ALJ) hearings; testify and defend the clinical basis for review determinations.
Minimum 10 ALJ appearances per month required.
Participate in Discussion and Education (D&E) sessions with providers and their representatives when disputes are escalated to the physician level.
Provide clinical oversight and quality assurance across the medical review function, ensuring determinations are consistent, well-documented, and defensible under Medicare coverage policy.
Actively engage with CMS on issue resolution, medical review policy interpretation, and emerging coverage questions; participate in CMS meetings and work groups as required.
Collaborate with the Project Manager, clinical reviewers, and operational leadership to support program performance, staff education, and continuous quality improvement.
Maintain currency with Medicare coverage policies, National Coverage Determinations (NCDs), Local Coverage Determinations (LCDs), and relevant IOM guidance (including IOM 100-8). 🎯 Requirements
Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO); board-certified in a relevant specialty.
Currently licensed to practice medicine in the United States; licensure must remain active and in good standing throughout employment.
Minimum 3 years of active medical practice experience post-residency.
Background in health insurance, utilization review, or healthcare claims processing, including familiarity with medical necessity criteria and coverage determination standards.
Demonstrated capacity for active, substantive engagement in medical review activities, issue resolution, and CMS-directed meetings — this position requires consistent hands-on participation and is not a nominal or figurehead role.
Prior Contractor Medical Director or Medical Director experience at a CMS review contractor preferred.
In-depth familiarity with Medicare coverage policy, National Coverage Determinations (NCDs), Local Coverage Determinations (LCDs), and Internet-Only Manual guidance, including IOM 100-8 preferred.
Experience participating in or leading ALJ hearing representation in a Medicare appeals context, including preparation of written testimony and presentation of clinical evidence preferred.
Multi-state medical licensure preferred given the nationwide scope of review activities. Apply Now 📊 Check your resume score for this job Improve your chances of getting an interview by checking your resume score before you apply. Check Resume Score Similar Jobs Director of Clinical Research 🔥 11 hours ago Tiny Health 11 - 50 🏥 Healthcare 🛍️ eCommerce 👥 B2C Website LinkedIn All Job Openings Director of Clinical Research at Tiny Health leading clinical studies to validate microbiome-based testing. Collaborating with cross-functional teams to deliver impactful insights. 🇺🇸 United States – Remote 💰 $8.5M Series A - Tiny Health on 2024-03 ⏰ Full Time 🔴 Lead 👨‍⚕️ Medical Director Quality Director – Medical Device, USCT 🔥 11 hours ago Midjourney 11 - 50 🤖 Artificial Intelligence ☁️ SaaS 👥 B2C Website LinkedIn All Job Openings Quality Director overseeing Quality Management System for regulated medical device development. Leading risk management and ensuring compliance with FDA regulations and design controls. 🇺🇸 United States – Remote ⏰ Full Time 🔴 Lead 👨‍⚕️ Medical Director Clinical Director 🔥 12 hours ago Allswell 11 - 50 🏥 Healthcare ⚕️ Healthcare Insurance Website LinkedIn All Job Openings Clinical Director leading clinical quality and care delivery at Allswell, focusing on affirming mental health for LGBTQ+ clients. Collaborating with clinicians on best practices and operational excellence. 🇺🇸 United States – Remote 🔥 Funding within the last year 💰 $1.3M Pre Seed Round - Allswell on 2025-10 ⏰ Full Time 🔴 Lead 👨‍⚕️ Medical Director Associate Medical Director – Principal, Payer Partnerships 🔥 12 hours ago Headway 501 - 1000 🏥 Healthcare 🏪 Marketplace ☁️ SaaS Website LinkedIn All Job Openings Associate Medical Director/Principal managing payer partnerships for Headway's innovative mental healthcare platform. Building relationships within healthcare systems, driving data analyses for patient outcomes. 🇺🇸 United States – Remote 💵 $179.2k - $300k / year 💰 $100M Series D - Headway on 2024-07 ⏰ Full Time 🔴 Lead 👨‍⚕️ Medical Director General Manager – Director of Clinical Operations, Psychiatry 🔥 13 hours ago Talkiatry 501 - 1000 🏥 Healthcare 👥 B2C Website LinkedIn All Job Openings General Manager overseeing day-to-day activities for a team of clinicians in mental health operations. Collaborate cross-functionally to drive operational efficiency and enhance clinician support. 🇺🇸 United States – Remote 💵 $165k - $175k / year ⏰ Full Time 🔴 Lead 👨‍⚕️ Medical Director View More Medical Director Jobs 🌐 Worldwide Built by Lior Neu-ner. I'd love to hear your feedback — Get in touch via DM or support@remoterocketship.com Search Search Jobs by country Search jobs by city Search jobs by job title Search entry-level jobs Search junior-level jobs Search senior-level jobs Search jobs by tech stack Search jobs by contract type Search remote internships Search remote part-time jobs Remote jobs Anywhere in the World Companies Hiring Anywhere in the World Companies Hiring Sales People Anywhere in the World Companies Hiring Software Engineers Anywhere in the World Resources Advice Tips for finding remote jobs Interview questions and answers Resume examples Cover letter examples Post a job Affiliates Is Remote Rocketship legit? Privacy policy Terms of service Job board SEO course Remote Job Search MasterClass AI Apply Copilot OpenClaw job finder Find jobs using your resume Jobs by Country Remote jobs anywhere in the world (Worldwide remote jobs) Remote jobs United States Remote jobs Australia Remote jobs Brazil Remote jobs Canada Remote jobs France Remote jobs Ireland Remote jobs Germany Remote jobs Netherlands Remote jobs Spain Remote jobs UK Popular Jobs Remote data analyst jobs Remote customer support jobs Remote executive assistant jobs Remote marketing jobs Remote product designer jobs Remote product manager jobs Remote project manager jobs Remote recruiter jobs Remote sales jobs Remote software engineer jobs Jobs by Type Remote full-time jobs Remote part-time jobs Remote contract jobs Remote internship jobs Remote entry-level jobs Remote jobs with no experience required Remote junior jobs (1-3 years of experience) Digital nomad jobs Remote jobs with no degree required Freelance remote jobs Temporary remote jobs Remote jobs hiring now Stay at home mom jobs