Medical Director (Medical Policy & Operations)

About the role

For our client, we are seeking a Medical Director (Medical Policy & Operations) to join the team of a leader in the Healthcare space. This remote role will provide clinical leadership across medical policy, claims review, and appeals support within a healthcare organization. The position partners closely with cross-functional teams to improve consistency, quality, and alignment between clinical decision-making and operational processes. It also serves as a clinical subject matter expert, helping identify opportunities for better outcomes and more effective service delivery. Location: Remote - US based candidates only, no visa sponsorship available.

Responsibilities

• Conduct clinical claim reviews and support the appeal process
• Serve as a clinical subject matter expert in work groups
• Analyze data to identify quality improvement opportunities
• Collaborate with multiple functional areas to support effective healthcare delivery
• Apply coding expertise to align medical policies with service requests

Qualifications

• 5+ years of experience in a health care delivery system
• Active state medical license with no encumbrances
• M.D. or D.O. with board certification in an ABMS-recognized specialty
• Post-graduate direct patient care experience
• Preferred experience in a health plan or payor system

Benefits

• Medical, dental, and vision coverage
• Paid time off
• Retirement savings options
• Wellness programs
• Comprehensive benefits package supporting overall well-being

Pay

$174,070 – $374,920 annually