Research Medical Director – Medicaid Medical Policy

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🔥 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

• Provide leadership guidance to clinical teams • Ensure Rules and policies are accurately interpreted and developed • Analyze, interpret, and develop policies to enhance the medical policy library • Guide internal and external processes related to Payment Policy Management policies and rules • Interpret and assess payment policy and medical coding information against the policy library • Research and analyze medical policy items • Perform multifaceted data and report analytics • Translate industry references into Cotiviti policy • Review and identify changes to maintain an accurate and current medical policy library • Identify new opportunities from clinical references and analytical sources • Analyze research inquiries and apply clinical judgment to determine potential impact on medical policies • Determine whether updates to policy logic or content are warranted • Perform quality assurance of policy reviews, logic revisions, and research requests • Provide feedback to originators as needed • Educate client-facing MDs and Client Policy Managers on changes and updates through monthly meetings • Ensure work is accurate, complete, timely, and properly documented • Maintain current knowledge of industry content, best practices, applications, procedures, and policies • Complete performance-review responsibilities, special projects, and assigned duties

🎯 Requirements

• A United States MD or DO degree is required • MBA degree preferred • 10+ years of research experience • Experience working with a Medicaid payer preferred • Knowledge of healthcare payers, payment policy, and correct coding preferred • In-depth knowledge of claims, claims adjudication, medical policy rules, and edits • Strong organizational and project management experience preferred • Proven success as a manager in a scalable organization with significant scope, complexity, and breadth • Strong personal leadership • Relationship development skills with key business partners and clients • Ability to achieve sustainable results through others, including developing and assigning MDs and administrative staff as leaders, mentors, and trainers • Ability to work independently and in a team environment • Ability to handle multiple tasks, prioritize, and meet deadlines • Highly organized • Excellent written and verbal communication skills and strong listening skills • Ability to work in a fast-paced, entrepreneurial environment with deep analysis, timely action, and thorough execution • Understanding of and ability to lead and manage in a matrix environment • Ability to make strategically relevant decisions • Ability to provide a dedicated, secure work area • High-speed internet access/connectivity and office setup and maintenance • Must be able to perform duties with or without reasonable accommodation

🏖️ Benefits

• Medical, dental, vision, disability, and life insurance coverage • 401(k) savings plan • Paid family leave • 9 paid holidays per year • 17–27 days of Paid Time Off (PTO) per year, depending on level and length of service • Remote work • Discretionary bonus consideration