Medical Director - Medicare
Cumberland County, PA
Business Group Highlights
The Risk Decision group is a mission-critical provider of specialized investigative services to a broad range of organizations spanning the federal, intelligence and civilian sectors. Leveraging a nationwide footprint of highly experienced investigators and subject matter experts, we provide critical information to support sensitive decisions.
Every day at Perspecta, we enable hundreds of thousands of people to take on our nations most important work. Were a company founded on a diverse set of capabilities and skills, bound together by a single promise: we never stop solving our nations most complex challenges. Our team of engineers, analysts, developers, investigators, integrators and architects work tirelessly to create innovative solutions. We continually push ourselvesto respond, to adapt, to go further. To look ahead to the changing landscape and develop new and innovative ways to serve our customers. Perspecta works with U.S. government customers in defense, intelligence, civilian, health care, and state and local markets. Our high-caliber employees are rewarded in many waysnot only through competitive salaries and benefits packages, but the opportunity to create a meaningful impact in jobs and on projects that matter. Perspectas talented and robust workforce14,000 strongstands ready to welcome you to the team. Lets make an impact together.
SafeGuard Services (SGS), a subsidiary of Enterprise Services, performs data analysis, investigation, and medical review to detect, prevent, deter, reduce, and make referrals to recover fraud, waste, and abuse.
Since 1999, SGS has prevented more than $9.3 billion in inappropriate payments, consisting of over $5.8 billion in proactively Prevented Dollars and $3.5 billion in Recovered Dollars. Our experience with fraud and abuse analytics has resulted in the referral of hundreds of cases to law enforcement and resulted in successful criminal and civil prosecution and civil monetary penalties.
The Medical Director must possess: Work Experience
Prior work experience in the health insurance industry, a utilization review firm, or another health care claims processing organization in a role that involved developing coverage or medical necessity policies and guidelines.
Extensive knowledge of the Medicare program, particularly the coverage and payment rules. Extensive knowledge of managed care policies and procedures.
Public relations experience such as working with physician groups, beneficiary organizations, and/or congressional offices is preferred.
Must have practiced medicine for at least three (3) years as a board-certified doctor of medicine or doctor of Osteopathic medicine.
Must be a board-certified Doctor of Medicine or Doctor of Osteopathic medicine. Degree must be obtained from an accredited institution. The Medical Director must have been board certified for at least three (3) years. All clinicians employed or retained as consultants must also be currently licensed to practice medicine in at least one U.S. state, territory, or the District of Columbia. The contractor shall ensure that the Medical Director and other physician consultants have active valid and unrestricted licenses.
What matters to our nation, is what matters to us. At Perspecta, everything we do, from conducting innovative research to cultivating strong relationships, supports one imperative: ensuring that your work succeeds. Our company was formed to bring a broad array of capabilities to all parts of the public sectorfrom investigative services and IT strategy to systems work and next-generation engineering.
Our promise is simple: never stop solving our nations most complex challenges. And with a workforce of approximately 14,000, more than 48 percent of which is cleared, we have been trusted to just that, as a partner of choice across the entire sector.
Perspecta is an AA/EEO Employer - Minorities/Women/Veterans/Disabled and other protected categories.
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As a government contractor, Perspecta abides by the following provision
PAY TRANSPARENCY NONDISCRIMINATION PROVISION
The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information. 41 CFR 60-1.35(c)