Medical Director

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

📋 Description

• Support the growth of existing clients and engage in new sales initiatives by identifying opportunities that create value for our clients.

• Present suitable payment policies to clients for adoption after analyzing data analytics.

• Collaborate with the Client Engagement Leader to define the mission and strategy; implement the strategy for the client’s medical policy team.

• Work in conjunction with the Medical Policy team to assess and validate editing processes.

• Serve as a clinical liaison for our health plan clients.

• Provide guidance to the research and development initiatives of our Medical Policy and Solutions teams.

• Possess extensive knowledge of claims, claims adjudication, medical policy edits, and configurations.

• Build trust and credibility, fulfill commitments, and deliver valuable analytics.

• Assist in identifying opportunities for additional Cotiviti product sales.

• Perform other assigned duties.

⛳️ Requirements

• Must be a licensed MD/DO with clinical experience and knowledge of health plan operations.

• Proven experience as a Medical Director in health plan operations, focusing on medical policy, medical coding, payment integrity, and/or fraud, waste, and abuse.

• Background in clinical medicine is essential.

• Ability to adapt to rapidly changing priorities and workloads, while multitasking, prioritizing, and meeting deadlines.

• Strong client relationship skills with the ability to cultivate professional relationships across various roles and levels.

• Comfortable presenting to both small and large audiences.

• Excellent organizational, analytical, and problem-solving abilities.

• Results-oriented with a commitment to delivering high-quality, error-free services and deliverables.

• Capability to work effectively both independently and as part of a team.

• Exceptional verbal and written communication skills.

• Proficient in Microsoft Office Suite (Word, Excel, PowerPoint); advanced proficiency in Excel is preferred.

• Demonstrates behaviors aligned with Cotiviti's values.

🏝️ Benefits

• Comprehensive medical, dental, vision, disability, and life insurance coverage.

• 401(k) savings plans.

• Paid family leave.

• Nine paid holidays annually.

• Between 17 to 27 days of Paid Time Off (PTO) per year, depending on specific level and tenure with Cotiviti.