Research Medical Director – Medicaid Medical Policy

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

📋 Description

• Provide leadership direction to clinical teams.

• Ensure that rules and policies are accurately interpreted and developed.

• Analyze, interpret, and develop policies to improve the medical policy library.

• Oversee internal and external processes related to Payment Policy Management policies and regulations.

• Interpret and evaluate payment policy and medical coding information in relation to the policy library.

• Conduct research and analysis on medical policy items.

• Execute comprehensive data and report analytics.

• Convert industry references into Cotiviti policy.

• Review and identify necessary updates to maintain a precise and current medical policy library.

• Discover new opportunities using clinical references and analytical sources.

• Analyze research inquiries and apply clinical judgment to assess potential impacts on medical policies.

• Determine if updates to policy logic or content are necessary.

• Conduct quality assurance on policy reviews, logic revisions, and research requests.

• Provide feedback to originators as required.

• Educate client-facing MDs and Client Policy Managers on changes and updates during monthly meetings.

• Ensure that work is accurate, complete, timely, and well-documented.

• Stay updated with current industry content, best practices, applications, procedures, and policies.

• Complete performance-review responsibilities, special projects, and assigned tasks.

⛳️ Requirements

• A United States MD or DO degree is mandatory.

• An MBA degree is preferred.

• Over 10 years of research experience is required.

• Experience with a Medicaid payer is preferred.

• Familiarity with healthcare payers, payment policy, and correct coding is preferred.

• Extensive knowledge of claims, claims adjudication, medical policy rules, and edits.

• Strong organizational and project management experience is preferred.

• Proven managerial success in a scalable organization with considerable scope, complexity, and breadth.

• Strong personal leadership skills.

• Skills in developing relationships with key business partners and clients.

• Ability to achieve sustainable results through others, including mentoring and assigning MDs and administrative staff as leaders and trainers.

• Capability to work independently as well as collaboratively within a team environment.

• Proficiency in handling multiple tasks, prioritizing, and meeting deadlines.

• Highly organized.

• Excellent written and verbal communication skills along with strong listening abilities.

• Competence to operate in a fast-paced, entrepreneurial environment requiring deep analysis, timely action, and thorough execution.

• Understanding of and capability to lead and manage in a matrix environment.

• Ability to make strategically relevant decisions.

• Capacity to provide a dedicated and secure work area.

• High-speed internet access/connectivity and proper office setup and maintenance are essential.

• Must be able to perform duties with or without reasonable accommodation.

🏝️ Benefits

• Coverage for medical, dental, vision, disability, and life insurance.

• 401(k) savings plan.

• Paid family leave.

• 9 paid holidays annually.

• 17–27 days of Paid Time Off (PTO) per year, contingent on level and length of service.

• Opportunity for remote work.

• Consideration for discretionary bonuses.