Medical Director

This is a fully remote position, open to applicants in United States.

📋 Description

• Facilitate growth for existing clients and drive new sales initiatives by pinpointing value-creation opportunities.

• Recommend suitable payment policies for client adoption based on a thorough data analytics assessment.

• Collaborate with the Client Engagement Leader to establish the mission and strategy, and effectively communicate it to the client’s medical policy team.

• Partner with the Medical Policy team to assess and confirm editing processes.

• Serve as a clinical liaison for health plan clients.

• Guide the research and development initiatives for the Medical Policy and Solutions teams.

• Act as a subject matter expert in claims, claims adjudication, medical policy edits, and configuration processes.

• Build trust and credibility, fulfill commitments, and provide value-added analytics.

• Support the identification of opportunities for additional Cotiviti product sales.

• Lead the joint Medical Policy Committee, which includes health plan MDs, coding specialists, and payment integrity experts.

• Analyze client data, choose medical policies to propose, and offer clinical and coding expertise along with backend support for the client’s Medical Director.

• Develop into a trusted advisor for health plans regarding medical payment policy.

• Execute other assigned tasks as necessary.

⛳️ Requirements

• MD/DO licensed with clinical experience and familiarity with health plans.

• Background in health plan operations as a Medical Director, particularly in medical policy, coding, payment integrity, or fraud, waste, and abuse.

• Experience in clinical medicine.

• Capacity to adjust to fast-changing priorities and workloads, multitask, prioritize, and meet deadlines.

• Ability to cultivate strong professional relationships across various roles and levels.

• Comfortable presenting to both small and large audiences.

• Strong organizational, analytical, and problem-solving capabilities.

• Results-oriented approach focused on delivering high-quality, error-free services and outputs.

• Competent in working both independently and as part of a team.

• Excellent verbal and written communication abilities.

• Proficient in Microsoft Office Suite, including Word, Excel, and PowerPoint.

• Advanced proficiency in Excel is preferred.

• Approximately 10% travel may be necessary.

• Ability to use a computer keyboard for extended durations.

• Availability for after-hours and/or weekend work may be required for significant deliverables or deadlines.

• Must provide a secure and dedicated workspace.

• Must ensure high-speed internet access/connectivity and manage office setup and maintenance.

• Must be able to remain in a stationary position, often standing or sitting for extended periods.

• Must be capable of performing repetitive motions involving the wrists, hands, and/or fingers.

🏝️ Benefits

• Consideration for discretionary bonuses.

• Coverage for medical insurance.

• Coverage for dental insurance.

• Coverage for vision insurance.

• Coverage for disability insurance.

• Coverage for life insurance.

• 401(k) savings plan options.

• Paid family leave benefits.

• 9 paid holidays each year.

• 17-27 days of Paid Time Off (PTO) annually, depending on specific level and tenure.

• Option for a work-at-home arrangement.

• Dedicated and secure workspace along with high-speed internet access/connectivity and office setup and maintenance required.