Medical Director - Remote

Who We Are
WPS Health Solutions is a leading not-for-profit health insurer and federal government contractor headquartered in Wisconsin. WPS offers health insurance plans for individuals, families, seniors, and group health plans for small to large businesses. We process claims and provide customer support for beneficiaries of the Medicare program and manage benefits for millions of active-duty and retired military personnel across the U.S. and abroad. WPS Health Solutions has been making health care easier for the people we serve for more than 75 years. Proud to be military and veteran ready.
Culture Drives Our Success
WPS' Performance-Based Culture is where the great work and innovations of our people are seen, fueled, and rewarded. We accomplish this by creating an inclusive and empowering employee experience. We recognize the benefits of Diversity, Equity, and Inclusion as an investment in our workforce-both current and future-to effectively seek, leverage, and include diverse perspectives that fuel agility and innovation on high-performing teams. This results in people bringing their authentic selves to work every day in an organization that successfully adapts to business changes and new opportunities.
From 2021 to 2023, WPS Health Solutions was recognized for several awards:

• Madison, Wisconsin's Top Workplaces
• USA Top Workplaces and the cultural excellence awards for Remote Work and Work-Life Flexibility
• Achievers 50 Most Engaged Workplaces® with the further honor of Achievers "Elite 8" winner in the category of Culture Alignment
• DAV Patriot Employer
• VETS Indexes 4 Star Employer
• BBB Torch Award for Ethics from Better Business Bureau of Wisconsin

Role Snapshot
Our full-time remote Medical Director is responsible for clinical coverage determinations and staff trainings on clinical matters. In addition, this role collaborates with medical societies and peer groups to share information and provide education. Lastly, the Medical Director is a physician leader with expert knowledge in Medicare appeals and regulations.
In addition, this role will:

• Work with RN(s) on local coverage determinations - reviewing new procedures that may involve new technology and determine if they believe Medicare program should cover
• Organize and facilitate Contractor Advisory Committee meetings (CAC) including, meeting and recruiting CAC members
• Work with Medical Review Clinical Team to help develop our Medical Review strategies
• Work with data analytics team to request data that they can analyze in an effort to determine if we have some aberrancy with a particular service or provider
• Ensure we are meeting clinical aspects of contracts
• Meet with CMS staff to provide updates
• Involved in responding to requests for proposals both new and existing contracts
• Respond to inquiries from providers and representatives of the medical industry regarding advanced medical solutions that may provide better patient treatments
• Provide consultation to law enforcement with investigations regarding fraudulent provider activity

How do I know this opportunity is right for me? If you:

• Enjoy having the ability to influence the delivery of health care
• Enjoy working in a team environment, while being remote
• Use your medical training in a new way
• Are a thought leader and confident in your decision-making
• Would welcome no weekends, holidays, swing shifts, and work life balance

What will I gain from this role?

• Working with CMS - the single largest payer for healthcare in the U.S.
• Having the ability to make recommendations on how to make sure health care is delivered in the most effective way
• Having the opportunity to work outside your specialty
• Experience working in an environment that serves our Nation's military, veterans, Guard and Reserves and Medicare beneficiaries
• Working in a continuous performance feedback environment.

Minimum Qualifications

• Five (5) years or more experience practicing physician, with experience in Medicare insurance policies and regulations
• One of the following credentials: MD or DO
• Board Certified in a Medical Specialty
• Valid medical license (in any state) with no federal sanctions
• Ability to travel up to 20%

Preferred Qualifications

• Medicare Fee for Service experience
• Experience with DME

Remote Work Requirements

• High speed cable or fiber internet
• Minimum of 10 Mbps downstream and at least 1 Mbps upstream internet connection (can be checked at https://speedtest.net)
• Please review Remote Worker FAQs for additional information

Salary Range

• $225,000 to $300,000
• The base pay offered for this position may vary within the posted range based on your job-related knowledge, skills and experience.

Work Location
We are a remote-first organization and offer remote work in the following approved states:
Arizona, Colorado, Connecticut, Florida, Georgia, Illinois, Indiana, Iowa, Michigan, Minnesota, Missouri, Nebraska, Nevada, New Jersey, North Carolina, North Dakota, Ohio, South Carolina, South Dakota, Texas, Virginia, Wisconsin
Benefits

• Remote option available
• Performance bonus and/or merit increase opportunities
• 401(k) with dollar-per-dollar match up to 6% of salary (100% vested immediately)
• Competitive paid time off
• Health insurance, dental insurance, and telehealth services start DAY 1
• Employee Resource Groups
• Professional and Leadership Development Programs
• Review additional benefits here

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Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
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)