Medical Director - CMS Medical Review (RVC)

Job Description

Job Description

At Broadway Ventures , we transform challenges into opportunities with expert program management, cutting-edge technology, and innovative consulting solutions. As an 8(a), HUBZone, and Service-Disabled Veteran-Owned Small Business (SDVOSB), we empower government and private sector clients by delivering tailored solutions that drive operational success, sustainability, and growth. Built on integrity, collaboration, and excellence, we're more than a service provider—we're your trusted partner in innovation.

The Medical Director serves as the senior clinical authority for the CMS Review and Validation Contractor (RVC) program. This role provides leadership and oversight for all medical review functions, ensuring compliance, clinical accuracy, and alignment with Medicare coverage and payment policy. The CMD must be available to CMS between 8 : 00 AM and 4 : 30 PM ET, Monday–Friday , and must be fully dedicated to the RVC contract.

Key Responsibilities

Oversee all aspects of medical review, validation activities, and quality assurance.

Direct clinical personnel on correct application of Medicare policy during the validation process.

Participate in CMS discussions, trainings, and policy interpretation sessions.

Oversee training and education of RVC medical reviewers.

Provide expert guidance on LCDs, NCDs, Medicare manuals, and all applicable medical policies.

Serve as an expert resource during complex or questionable claim reviews.

Monitor changes in medical practices and technology that may affect billing or improper payment risks.

Recommend updates to LCDs, NCDs, system edits, and corrective actions based on RAC-identified vulnerabilities.

Participate in CMS / RVC clinical workgroups and presentations as needed.

Maintain compliance with conflict-of-interest reporting requirements.

Ensure non-medical staff do not perform or oversee tasks requiring clinical judgment.

Required Qualifications Experience

Minimum 3 years of clinical practice as a board-certified physician with no Medicare sanctions or exclusions.

Minimum 2 years of experience in :

Health insurance

Utilization review

Claims processing

Medicare or federal healthcare program administration

Extensive knowledge of Medicare coverage, billing, and payment rules.

Experience working with physician groups, beneficiary organizations, and / or congressional offices preferred.

Working knowledge of the CMS Fee-for-Service (FFS) Recovery Audit Program .

Education & Licensure

Doctor of Medicine (MD) or Doctor of Osteopathy (DO), board-certified .

Active, unrestricted license to practice medicine in a U.S. state or territory (verified annually).

Core Competencies

Expert understanding of Medicare policy, LCDs, NCDs, and clinical review requirements.

Strong clinical judgment and analytical skills.

Ability to lead, mentor, and direct multidisciplinary review teams.

Excellent communication and documentation skills.

Professional integrity and ability to make independent, impartial clinical determinations.

Work Requirements

Full-time, fully dedicated role; may not perform work for other Medicare or non-Medicare contracts without CMS approval.

Availability required between 8 : 00 AM and 4 : 30 PM ET, Monday–Friday .

What to Expect Next :

After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with a recruiter to verify resume specifics and discuss salary requirements. Management will be conducting interviews with the most qualified candidates. We perform a background and drug test prior to the start of every new hires' employment. In addition, some positions may also require fingerprinting.

Broadway Ventures is an equal-opportunity employer and a VEVRAA Federal Contractor committed to providing a workplace free from harassment and discrimination. We celebrate the unique differences of our employees because they drive curiosity, innovation, and the success of our business. We do not discriminate based on military status, race, religion, color, national origin, gender, age, marital status, veteran status, disability, or any other status protected by the laws or regulations in the locations where we operate. Accommodations are available for applicants with disabilities.