The Medical Research Consultant provides central research coordination for the Medical Affairs department by conducting comprehensive literature searches and systematic reviews. They synthesize research findings to support the development and revision of Local Coverage Determinations (LCDs) and collaborate with interdisciplinary teams to provide actionable clinical insights.
The analyst is responsible for translating industry and government compliance requirements into IT security frameworks and overseeing the remediation of non-compliant areas. They also perform vendor security assessments and monitor information security risks across the organization.
This position manages the medical affairs team in developing and implementing local coverage determinations and contractor pricing for Medicare beneficiaries. The role also involves collaborating with Contractor Medical Directors to resolve complex clinical inquiries and ensuring compliance with CMS regulations.
The Clinical Review Nurse evaluates health claims for medical necessity and appropriateness based on national and local policies. They also identify provider issues, conduct corrective actions, and provide education to healthcare providers regarding review processes.
