Executive Medical Director, Payment Integrity (Hybrid)

Health Care Service Corp.; Richardson (TX); Hybrid; USD 215,000 - 399,000; Full time

Benefits offered by this job

Flex (Hybrid) schedule

Total rewards package

Job summary

Health Care Service Corporation is seeking a physician-lead to oversee medical policies and programs, performing reviews and engaging with provider communities. The role emphasizes strategic leadership, collaboration, and data-driven decision making to support managed care initiatives.

The candidate will apply clinical expertise to business strategies, lead teams, present recommendations, and manage budgets to optimize ROI while aligning with corporate goals.

Qualifications

• MD or DO with full, unrestricted medical license in the U.S.
• Board certification in a relevant medical specialty
• 5 years post-graduate clinical experience
• 5 years managed care experience applying medical problems to managed care
• Knowledge of medical/surgical techniques, reimbursement, and benefits management
• Leadership skills to guide groups toward consensus and strategic actions
• Strong verbal and written communication skills
• Experience achieving results through people
• Ability to meet deadlines under pressure and drive results
• Experience innovating and improving processes to align with business strategy
• Subject matter expert in a specified field
• Experience presenting and negotiating
• Strategic thinking skills
• Proficiency with computing and documentation tools (MS Office, Lotus Notes)
• Overseeing annual budget and allocating resources
• Translating needs into compelling business cases
• Conducting cost-benefit analyses to justify investments and ROI

Responsibilities

• Perform medical reviews and interact with provider communities for assigned areas
• Lead groups to consensus and convert strategy into action
• Translate clinical needs into actionable business cases
• Present findings and negotiate with stakeholders
• Oversee budget and allocate resources for projects

Skills

Leadership

Strategic thinking

Communication skills

Negotiation

Budget management

Process improvement

Medical policy

Office software

Education

MD or DO

Board certification

Tools

Microsoft Office

Lotus Notes

Job description

Health Care Service Corporation is seeking a physician-lead to oversee medical policies and programs, performing reviews and engaging with provider communities. The role emphasizes strategic leadership, collaboration, and data-driven decision making to support managed care initiatives.

The candidate will apply clinical expertise to business strategies, lead teams, present recommendations, and manage budgets to optimize ROI while aligning with corporate goals.