Executive Medical Director-Payment Integrity

hcsc; Richardson (TX); Hybrid; USD 215,000 - 399,000; Full time

Benefits offered by this job

Hybrid work arrangement

Total rewards package

Job summary

Health Care Service Corporation seeks a physician leader responsible for medical policy and program oversight, performing medical reviews, and engaging with provider communities. The role emphasizes strategic decision-making and cross-functional collaboration to advance corporate strategy.

The candidate should have extensive clinical experience, board certification, and strong leadership and negotiation skills to deliver impactful policy initiatives.

Qualifications

• Physician license in a state or territory of the United States.
• Board certification by a recognized medical board.
• Minimum 5 years of post-graduate patient care/clinical experience.

Responsibilities

• Perform medical reviews for assigned areas and interact with provider communities.
• Lead groups to consensus and align actions with corporate strategy.
• Translate needs into compelling business cases and drive strategic initiatives.
• Oversee budgets and allocate resources for projects and operations.

Skills

Leadership

Strategic thinking

Communication skills

Cost-benefit analyses

Results oriented

Decision making

Negotiation

Project management

Proactive

Education

MD/DO medical license (US)

Board certification (ABMS/NBPMs/ABOS)

Tools

Microsoft Office

Lotus Notes

Job description

At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers.

Join HCSC and be part of a purpose-driven company that will invest in your professional development.

Job Summary

This position is responsible for assigned aspects of medical policies and programs. Performs medical reviews and interacts with the provider communities for assigned areas.

JOB REQUIREMENTS

• Physician (M.D. or D.O) with a current and unrestricted physician license in a state or territory of the United States
• Maintain Board Certification by a specialty board approved by the American Board of Medical Specialties, National Board of Physicians and Surgeons, or the Advisory Board of Osteopathic Specialists
• 5 years of post-graduate patient care/clinical experience.
• 5 years of managed care experience coupled with proven experience in the application of medical problems to managed care practices.
• Knowledge of current medical and surgical techniques, reimbursement methodology, and benefit management.
• Leadership skills to lead groups to consensus and resolution building aligned to corporate strategy
• Demonstrated ability to independently make tough strategic decisions and move forward with actions on the strategies.
• Strong verbal and written communication skills.
• Experience achieving results through people.
• Experience being proactive and highly results oriented; able to meet deadlines under pressure.
• Experience thinking innovatively and developing process improvements to align with business strategies.
• Experience being the subject matter expert/leader in a specified field.
• Experience presenting and negotiating.
• Strategic thinking skills.
• Proficiency in computer use (including software applications such as Microsoft Office Product, Lotus Notes) needed for electronic documentation of case reviews
• Overseeing the annual budget and allocating resources for various projects and operational needs.
• Translating needs and initiatives into compelling business cases.
• Conducting cost-benefit analyses to justify investments and ensure ROI.

PREFERRED EXPERIENCE

• Experience developing business strategies, leading broad medical policy initiatives.

PREFERRED EXPERIENCE

• Experience developing business strategies, leading broad medical policy initiatives.
• Legal/compliance experience
• Payment integrity/ Reimbursement experience

This is a Flex (Hybrid) role: 3 days in office; 2 days remote.

Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!

Pay Transparency Statement

At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for employees. Learn more about our benefit offerings by visiting https://careers.hcsc.com/totalrewards .

The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan.

Flex employees are expected to be in the office a minimum of three days a week. Management will have discretion to modify an employee's weekly schedule for exigent circumstances.

HCSC Employment Statement

We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics. We are a drug-free and smoke-free workplace. Employment may be contingent upon successful completion of drug screening in accordance with applicable law.

Base Pay Range

$214,800.00 - $398,900.00

Exact compensation may vary based on skills, experience, and location.