Executive Medical Director-Payment Integrity

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

Job summary

HCSC is seeking an experienced Medical Policy Lead to manage assigned policy areas, perform medical reviews, and engage with provider communities. The role requires an MD or DO with active license and board certification, plus extensive clinical and managed care experience.

The hybrid role offers in-office collaboration and remote work, with a compensation range of $214,800 to $398,900 depending on skills and location. Join a purpose-driven organization investing in professional development.

Qualifications

• MD or DO with active U.S. license
• Board certification by ABMS / NBPM? or equivalent
• 5+ years clinical care experience
• 5+ years managed care experience
• Knowledge of medical techniques, reimbursement, and benefits
• Leadership and strategic thinking abilities
• Strong verbal and written communication skills
• Experience guiding teams to outcomes and ROI analyses

Responsibilities

• Responsible for assigned medical policy areas and programs
• Perform medical reviews and interact with provider communities

Skills

MD/DO license

Board Certification

Clinical experience (5+ yrs)

Managed care experience (5+ yrs)

Medical knowledge

Leadership skills

Strategic decision making

Communication skills

Budgeting experience

ROI analyses

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.