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Duluth, MN

PRACTICE SPECIFICS

• Comprehensive, general adult PM&R practice including physiatric consultation and management for neurologic, limb loss and spine conditions.
• Majority outpatient practice with rotation on the inpatient rehab service. Approximately 1:10 call.
• Work collaboratively with Neurosurgery, Occupational Medicine, Interventional Pain in the management of patients with acute and chronic spine conditions. Collaboration with General and Interventional Neurology and Neurosurgery in the management of patients with neurologic conditions.
• Actively involved with the maintenance of a comprehensive spine program within the Essentia Health System
• Participation in regular spine management conferences: peer colleague case reviews
• Practice could include electrodiagnostic studies
• Additional procedural opportunities may include botulinum toxin injections, baclofen pump management.
• Outpatient therapy access to therapists who sub-specialize in neuro, pediatric and musculoskeletal conditions.
• We enjoy excellent working relationships in a comprehensive health system with a full continuum of Neuromusculoskeletal specialists including Neurosurgery, Neurology, Trauma/Critical Care, Medical and Surgical Orthopedics, Interventional Radiology, Interventional Pain, Internal Medicine and medical subspecialties.
• Regional outreach
• Assessment and management of patients with long term functional limitations; development of a plan of care in consultation with other specialists
• Join a 7-physician practice including 5 adult and 2 pediatric Physiatrists

REQUIREMENTS

• BC/BE in PM&R

LOCATION

• Duluth, MN – located at the westernmost tip of Lake Superior
• 150 miles north of Minneapolis/St. Paul
• Duluth population: 86,000; Regional service area: 460,000

COMPENSATION

$333.000. Hired candidates may be eligible to receive additional compensation in the form of bonuses, quality incentives or production-based compensation.

For additional information, contact: 

Carri Prudhomme, Senior Physician Recruiter

Cell: 218-786-3907

Email: Carri.Prudhomm@

Job Title: Medicare Contractor Medical Director (CMD) – Physical Medicine & Rehabilitation (PM&R Focus)

Employment Type: Full-Time

Work Environment: Remote with limited travel (approximately 3–4 weeks per year, based on business needs)

Position Summary

The Medicare Contractor Medical Director (CMD) provides senior-level medical leadership and clinical decision-making in support of the Medicare program and serves as a liaison between healthcare stakeholders and the Centers for Medicare and Medicaid Services (CMS).

This role plays a critical part in developing Local Coverage Determinations (LCDs), ensuring compliance with Medicare policies, reviewing complex medical claims, and advancing evidence-based healthcare practices. The position is ideally suited for a board-certified PM&R physician with strong clinical expertise, policy acumen, and a passion for provider education and quality improvement.

Essential Duties & Responsibilities

Clinical Expertise & Consultation (30%)

• Provide leadership in clinical program outreach to practitioners, providers, suppliers, and beneficiaries.
• Guide and support clinical staff in provider education initiatives and clinical guideline development.
• Maintain current knowledge of medical practice standards and emerging healthcare technologies.
• Serve as a subject matter expert in medical and clinical issues relevant to the Medicare population.
• Provide clinical consultation to internal teams (medical review, appeals) and external stakeholders.
• Apply scientific literature review and claims data analytics to inform medical policy and identify high-risk or problem areas.

Collaboration & Leadership (30%)

• Collaborate with CMS and other Medicare contractors to develop and update medical policies and coverage articles in accordance with clinical evidence and regulatory requirements.
• Work with multidisciplinary teams to improve operational processes and ensure compliance with CMS directives.
• Liaise with CMS staff, medical societies, and other stakeholders to align objectives and address emerging issues.
• Represent the organization at CMS meetings and professional conferences.
• Strengthen quality improvement initiatives with emphasis on decision consistency and clinical staff education, including oversight of Inter-Reviewer Reliability (IRR) activities

Program Integrity (20%)

• Support program integrity efforts by identifying trends in inappropriate billing or noncompliance.
• Ensure correct application of Medicare regulations, National Coverage Determinations (NCDs), LCDs, and clinical guidelines.
• Lead all phases of LCD development, including creation, revision, retirement, education, and policy decision-making.
• Collaborate with investigative teams and law enforcement when required.

Medical Review & Appeals (10%)

• Oversee medical review activities to ensure accurate and consistent claim determinations (pre- and post-payment).
• Develop and implement Medical Review Quality Assurance programs and internal review guidelines.
• Review complex or high-level appeals and provide expert guidance on Medicare policy application.
• Support the appeals process through position paper development and participation in administrative hearings (e.g., ALJ hearings).

Provider Education & Communication (10%)

• Provide leadership within the provider community, including engagement with hospital and specialty associations.
• Educate providers individually and in group settings on medical policies and identified compliance issues.
• Maintain strong professional relationships with internal teams and external partners.

Required Qualifications

• MD or DO degree from an accredited medical school.
• Minimum of three (3) years of clinical practice experience as an attending physician.
• Extensive knowledge of the Medicare program, including coverage and payment rules.
• Experience in health insurance, utilization review, or healthcare claims processing involving development of medical necessity or coverage policies.
• Demonstrated ability to evaluate clinical evidence and develop evidence-based medical necessity standards within the Medicare fee-for-service structure.
• Basic understanding of medical coding conventions.
• Strong communication skills with the ability to educate internal teams and external stakeholders on healthcare policy.
• Proven ability to collaborate with clinical and non-clinical staff to assess billing, coding, utilization, and compliance issues.
• Public speaking proficiency and experience delivering provider education.
• Computer literacy, including word processing, spreadsheets, presentations, and virtual meeting tools.
• Ability to complete independent and computer-based training.

Licensure & Certification Requirements

• Current, active, unrestricted license to practice medicine in at least one U.S. state or territory (never suspended or revoked).
• Eligible for licensure in applicable jurisdictions.
• Board Certified (MD or DO) in a specialty recognized by the American Board of Medical Specialties for a minimum of three (3) years.

Preferred Qualifications

• Board-certified Physical Medicine & Rehabilitation (PM&R) physician with at least five (5) years of clinical practice.
• Experience in Internal Medicine, Oncology, Radiology, Ophthalmology, or Infectious Diseases.
• MBA, MHA, MS in Management, or formal coursework in healthcare or medical systems management.
• Prior Medical Director experience in Medicare or commercial healthcare organizations.
• Coding and billing experience using HCPCS, CPT, and ICD-10 codes.
• Experience using GRADE methodology and conducting systematic literature reviews.
• Leadership experience in organized medicine (e.g., specialty societies, state health departments).
• Experience working with physician groups, beneficiary organizations, or congressional offices.

Travel Requirement

• Travel within and outside assigned jurisdictions as needed (estimated 3–4 weeks annually, subject to business needs).

EOC

Ascendo is a certified minority owned staffing firm, and we welcome and celebrate diversity.

Ascendo is an Equal Opportunity Employer and does not discriminate on the basis of race, color, religion, sex (including pregnancy and gender identity), national origin, political affiliation, sexual orientation, marital status, disability, genetic information, age, parental status, military service or any other characteristic protected by federal, state or local law