This role focuses on medical director oversight for molecular diagnostics within Medicare, with an emphasis on utilization review, policy development, and coverage decision support. The clinician reviews medical and regulatory cases, evaluates emerging technologies and evidence, and serves as a resource to providers and internal teams on policy questions. The work is primarily administrative and consultative rather than direct patient care, with collaboration across medical, regulatory, and operational teams.
Key Responsibilities
- Conduct case reviews for medical and regulatory matters.
- Develop claim adjudication criteria for situations requiring medical judgment.
- Review utilization data, practice pattern analysis, and other statistical information.
- Research new or controversial molecular diagnostic procedures and technologies.
- Develop, write, and revise medical policies to support Medicare coverage decisions.
- Educate staff and the medical community on medical policy and program administration.
- Serve as a liaison to providers, medical consultants, professional societies, and contractors.
- Provide input on operational policies, processes, and procedures.
Required
- Doctor of Medicine (MD) degree with an active license to practice medicine.
- Active state medical license.
- Current board certification in a recognized specialty.
- At least 5 years of post-graduate experience in direct patient care.
- Proficiency with Microsoft Office Suite.
Preferred
- Molecular Genetic Pathology fellowship training.
- Clinical Genetics fellowship training.
- Clinical laboratory directorship experience.
- Medicare experience.
- Experience interpreting medical evidence.
- Scientific research experience with publication history in molecular diagnostics.
Benefits & Perks
- Full-time schedule with Monday-Friday work hours.
- Remote work option in the United States or onsite work in Columbia, SC.
- Subsidized health, dental, and vision coverage.
- 401(k) retirement savings plan with company match.
- Life insurance.
- Paid time off.
- Education assistance.
- On-site cafeterias and fitness centers in major locations.