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Mgr Medical Affairs-Novitas
European Wax CenterRemote, FL, United States, United StatesRemotefull_timeVerifiedPosted 23 Jun 2026
About the role
Are you interested in joining a team of experienced healthcare experts and have the ability to shape and transform the healthcare delivery system? At our family of companies, everything we do is to help improve the lives of the nearly 12 million Medicare beneficiaries we serve and 700,000 health care providers who care for them. It is our goal to help create a better health experience for all consumers. Join our winning culture and help transform Medicare for the millions of people who rely on its services.
Benefits info:
* Medical, dental, vision, life and supplemental insurance plans effective the first day of the month following date of hire
* Short- and long-term disability benefits
* 401(k) plan with company match and immediate vesting
* Free telehealth benefits
* Free gym memberships
* Employee Incentive Plan
* Employee Assistance Program
* Rewards and Recognition Programs
* Paid Time Off and Paid Sick Leave
Benefits info:
* Medical, dental, vision, life and supplemental insurance plans effective the first day of the month following date of hire
* Short- and long-term disability benefits
* 401(k) plan with company match and immediate vesting
* Free telehealth benefits
* Free gym memberships
* Employee Incentive Plan
* Employee Assistance Program
* Rewards and Recognition Programs
* Paid Time Off and Paid Sick Leave
SUMMARY STATEMENT
This position is responsible for managing/directing the medical affairs team including Research Analysts, Pricing Consultants, Policy Nurses, Business Analysts, Medical Research Consultants, and other specialized personnel in project endeavors related to the development, implementation, operationalizing, and communication/education of local coverage determinations and local contractor pricing. The position is also accountable for handling complex medical policy inquiries and collaborating and supporting the Contractor Medical Directors (CMDs) regarding clinical/medical decision making for both First Coast and Novitas. These functions are detailed in the section below.
This position is responsible for managing/directing the medical affairs team including Research Analysts, Pricing Consultants, Policy Nurses, Business Analysts, Medical Research Consultants, and other specialized personnel in project endeavors related to the development, implementation, operationalizing, and communication/education of local coverage determinations and local contractor pricing. The position is also accountable for handling complex medical policy inquiries and collaborating and supporting the Contractor Medical Directors (CMDs) regarding clinical/medical decision making for both First Coast and Novitas. These functions are detailed in the section below.
ESSENTIAL RESPONSIBILITIES
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. This list of essential job functions is not exhaustive and may be supplemented as necessary.
Leads the First Coast/Novitas Medical Policy Team and manages the following functions: (85%)
* In conjunction with the CMDs, responsible for all Local Coverage Determinations (LCD) activities which include LCD clinical evidence research to determine validity of evidence, LCD development, internal/external LCD communication and education, LCD analysis for revision or retirement, creation of coverage and billing coding articles relating to LCDs, LCD effectiveness and LCD reconsideration requests.
* Responsible for the timely establishment and implementation of effective LCD edits in the Multi-Carrier System (MCS) and Fiscal Intermediary Shared System (FISS) to operationalize all LCDs to ensure the accurate processing of claims. Ensures education is provided on the LCD and LCD edits to all operational areas (i.e., Claims, Appeals, Medical Review, Prior Authorization, Informatics, etc.).
* Responsible for oversight of stakeholder engagement and transparency regarding LCD and local pricing activities.
* Responsible for the Contractor Advisory Committee, a group of external healthcare professionals who are informed of the evidence used in developing LCDs and who promote communications between First Coast and Novitas and the healthcare community, to include ensuring inclusive membership and scheduling/facilitating all required meetings.
* Responsible for the oversight of scheduling/facilitating all Open meetings which are required by CMS to allow interested external parties the opportunity to make presentations of information and offer comments related to new proposed LCDs.
* Responsible for receiving, assigning, tracking, and ensuring the timely completion of all CMD, medical policy, pricing, coding, and clinical inquiries from operations, stakeholders, CMS, law enforcement, other CMS contractors, etc.
* Responsible for receiving, assigning, tracking, and ensuring the timely completion of all CMD Assistance requests from all operational areas to resolve outstanding clinical issues/questions.
* Responsible for the oversight of contractor pricing to create local fees for procedure codes and services not priced by CMS and ensuring the fees are readily available to all operational areas (i.e., Claim, Appeals, Medical Review (MR), Prior Authorization, Informatics, etc.).
* Provides daily supervision to team members, including oversight of workload, tracking progress and status of activities and projects, and ensuring that commitments are met in a timely, accurate, and efficient manner in compliance with all Centers for Medicare & Medicaid Services (CMS) rules and regulations.
* Provides ongoing and timely communication to the team and operational areas.
* Ensures the professionalism and proper conduct of the team and provides technical, clinical, and professional training/guidance as nec
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