Executive Medical Director-Payment Integrity

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

Job summary

HCSC seeks a physician leader to oversee medical policies and programs. The role involves medical reviews and collaboration with provider communities to ensure effective policy application. Strong leadership, strategic thinking, and ROI focus are essential for success.

Ideal candidates have an active MD/DO license, board certification, and at least five years in clinical and managed care settings. The position is hybrid with in-office and remote work flexibility, offering substantial

Qualifications

• Physician with an active license in the U.S.
• Board certification in a medical specialty
• Minimum 5 years of clinical experience
• Minimum 5 years in a managed care setting
• Ability to lead groups and build consensus
• Strong strategic and decision-making capability
• Excellent verbal and written communication
• Experience managing budgets and resources
• Ability to justify investments with ROI analyses
• Proficient with standard office software for case reviews

Responsibilities

• Oversee assigned aspects of medical policies and programs.
• Perform medical reviews and interact with provider communities.
• Translate needs into compelling business cases and ROI analyses.
• Lead policy initiatives aligned to corporate strategy.

Skills

MD/DO license

Board Certification

Clinical experience

Managed care experience

Leadership skills

Strategic decision making

Communication skills

Budgeting/Resource allocation

Cost-benefit analyses

MS Office / Lotus Notes

Education

Medical Degree (MD/DO)

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.

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.

Compensation: $214,800.00 - $398,900.00

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

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.

To learn more about available benefits, please click https://careers.hcsc.com/totalrewards