Medical Director

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $225k - $275k / year

⏰ Full Time

🔴 Lead

👨‍⚕️ Medical Director

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Cotiviti

WebsiteLinkedInAll Job Openings

5001 - 10000 employees

🏥 Healthcare

💼 Consulting

📦 Logistics

Healthcare • Consulting • Logistics

Cotiviti is a healthcare technology and analytics company that specializes in improving payment accuracy and performance through advanced data analytics solutions. They partner with health plans, government agencies, and healthcare providers to deliver insights that enhance quality and efficiency in care delivery. With solutions such as risk adjustment, payment policy management, and member engagement, Cotiviti aims to optimize financial and clinical outcomes for the healthcare ecosystem.

📋 Description

• Support existing client growth and new sales activity by identifying value-creation opportunities • Present appropriate payment policy to clients for adoption based on data analytics review • Define mission and strategy with the Client Engagement Leader and deliver strategy to the client’s medical policy team • Work with the Medical Policy team to evaluate and validate editing • Act as a clinical liaison with health plan clients • Guide research and development efforts for Medical Policy and Solutions teams • Serve as a subject matter expert in claims, claims adjudication, medical policy edits, and configurations • Build trust and credibility, deliver on commitments, and provide value-added analytics • Assist in discovering opportunities for other Cotiviti product sales • Direct the joint Medical Policy Committee with health plan MDs, coding experts, and payment integrity professionals • Review client data, select medical policy to present, and provide clinical and coding expertise and backend support for the client’s Medical Director • Evolve as a trusted advisor to the health plan on medical payment policy • Perform other duties as assigned

🎯 Requirements

• Licensed MD/DO with clinical and health plan experience • Experience in health plan operations as a Medical Director, focused on medical policy, medical coding, payment integrity, and/or fraud, waste, and abuse • Experience in clinical medicine • Ability to adapt to rapidly changing priorities and workloads, multitask, prioritize, and meet deadlines • Ability to develop strong professional relationships across multiple roles and levels • Comfortable presenting to small and large groups • Strong organizational, analytical, and problem-solving skills • Results-driven focus on high-quality, error-free service and deliverables • Ability to work independently and in a team environment • Excellent verbal and written communication skills • Proficiency with Microsoft Office Suite, including Word, Excel, and PowerPoint • Advanced Excel proficiency preferred • Approximately 10% travel required • Able to use a computer keyboard for extended periods • After-hours and/or weekend work may be required for major deliverables or deadlines • Must provide a dedicated, secure work area • Must provide high-speed internet access/connectivity and office setup and maintenance • Must be able to remain stationary, often standing or sitting for prolonged periods • Must be able to perform repetitive motions involving the wrists, hands, and/or fingers

🏖️ Benefits

• Discretionary bonus consideration • Medical insurance coverage • Dental insurance coverage • Vision insurance coverage • Disability insurance coverage • Life insurance coverage • 401(k) savings plans • Paid family leave • 9 paid holidays per year • 17-27 days of Paid Time Off (PTO) per year, depending on specific level and length of service • Work-at-home arrangement • Dedicated, secure work area and high-speed internet access/connectivity and office setup and maintenance required