Medical Director-Payment Integrity

About the role

For our client, we are seeking a Medical Director-Payment Integrity to join the team of a leader in the Healthcare space. This role will support clinical priorities focused on quality, patient-centered outcomes, and effective care delivery. You will collaborate with clinical leaders, operational teams, and cross-functional stakeholders to improve standards, workflows, and execution. The position offers the opportunity to strengthen care quality, team performance, and measurable outcomes within a healthcare environment.

Location: Remote - US based candidates only, no visa sponsorship available

Compensation: $223,800 – $313,100 annually

Responsibilities

• Provide medical determinations aligned with national guidelines and CMS requirements
• Collaborate with team members and departments to ensure compliance and quality care
• Conduct computer-based reviews of clinical scenarios and records
• Prioritize daily tasks and communicate decisions effectively
• Support market-wide objectives and community relations as directed
• Engage in post-service reviews for billing accuracy
• Participate in project teams or organizational committees as necessary

Qualifications

• MD or DO degree required
• 5+ years of clinical patient care experience, preferably in inpatient settings
• Current Board Certification in an ABMS-approved specialty
• Unrestricted medical license in at least one jurisdiction
• No current sanctions from government organizations and able to pass credentialing
• Strong verbal and written communication skills
• Analytical skills with team experience in quality or case management

Benefits

• Comprehensive medical, dental, and vision plans
• 401(k) retirement savings plan
• Paid time off, including holidays and parental leave
• Short-term and long-term disability coverage
• Life insurance options
• Support for personal wellness and smart healthcare decisions