Executive Medical Director, Payment Integrity (Hybrid)

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

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