Medical Director

Responsibilities

Supports existing client growth and new sales activity by identifying value-creation opportunities for our clients.

Presents appropriate payment policy to clients for adoption based on review of data analytics.

Defines mission and strategy with Client Engagement Leader; delivers strategy to client’s medical policy team.

Works alongside Medical Policy team to evaluate and validate editing.

Acts as a clinical liaison with our health plan clients.

Lend guidance to the research & development efforts of our Medical Policy and Solutions teams.

Have in-depth knowledge of claims, claims adjudication, medical policy edits and configurations.

Inspire trust and credibility, deliver on commitments, provide value-add analytics.

Assist in discovering opportunities for other Cotiviti product sales.

Qualifications

• Licensed MD/DO with clinical and health plan experience.
• Experience in Health plan operations as a Medical Director, with focus on medical policy, medical coding, payment integrity and/or fraud/waste/abuse.
• Experience in clinical medicine.
• Adaptive capacity for rapidly changing priorities and workloads, multitasking, prioritizing and meeting deadlines.
• Client Relationship Skills - Ability to develop strong professional relationships with multiple roles and levels. Comfortable with presenting to small and large groups of people.
• Strong organizational, analytical and problem-solving skills.
• Results driven with focus on producing high-quality, error free service and deliverables.
• Ability to work well independently and in a team environment.
• Excellent verbal and written communication skills.
• Proficient with Microsoft Office Suite (Word, Excel, Power Point); advanced Excel proficiency preferred.
• Exhibits behaviors consistent with Cotiviti values.

Job Demands

• The role can work at home anywhere in the continental United States (some travel is required ~10%).
• Able to use computer keyboard for extended periods of time.
• Able to work after hours and/or weekends where necessary for major deliverables /deadlines.

Mental Requirements

Communicating with others to exchange information.

Assessing the accuracy, neatness, and thoroughness of the work assigned.

Physical Requirements And Working Conditions

• Remaining in a stationary position, often standing or sitting for prolonged periods.
• Repeating motions that may include the wrists, hands, and/or fingers.
• Must be able to provide a dedicated, secure work area.
• Must be able to provide high-speed internet access/connectivity and office setup and maintenance.
• No adverse environmental conditions expected.

Pay

Base compensation ranges from $225,000 to $275,000 per year.

Schedule

This role is eligible for discretionary bonus consideration.