Medical Director

Tacony Corporation; Trenton (NJ); On-site; USD 62,000 - 110,000; Full time

Benefits offered by this job

Health and Life Insurance Plans

Dental and Vision Plans

401(k) with company match

Paid Time Off and Holiday Pay

Maternity/Paternity Leave

Casual Dress Environment

Tuition Reimbursement

MTM Perks Discount Program

Leadership Mentoring Opportunities

Job summary

MTM is seeking a Medical Director to provide clinical oversight for Non-Emergency Medical Transportation (NEMT) under NJ Medicaid. You will ensure compliance, guide medical necessity policies, and liaise with providers, beneficiary groups, and internal teams.

The role emphasizes Medicaid expertise, utilization review experience, and collaboration to improve access to care. Position contingent on contract award and involves public relations activities with healthcare partners.

Qualifications

• Licensed professional in NJ with active, unrestricted license.
• Strong Medicaid experience in health insurance.
• Deep understanding of NJ Medicaid programs, coverage and payment rules.
• 3+ years with a utilization review firm or claims processing organization.
• Experience developing coverage or medical-necessity policies and guidelines.

Responsibilities

• Ensure NEMT services meet medical necessity and NJ Medicaid requirements.
• Review and approve medical policies related to transportation eligibility.
• Develop and maintain coverage and medical-necessity policies.
• Collaborate with internal teams to improve claims processing and utilization review.
• Act as a clinical liaison with physician groups, beneficiary organizations, and regulators.
• Provide public relations support and represent MTM in meetings with providers and partners.
• Ensure adherence to NJ Medicaid coverage and payment rules.
• Monitor and evaluate clinical processes for efficiency and compliance.

Skills

Communication skills

Analytical/problem solving

Cross-functional collaboration

Healthcare compliance knowledge

HIPAA/PHI handling

Education

Active NJ medical license (MD/DO) or NP/RN

Job description

What will your job look like?

The Medical Director will provide clinical oversight and guidance for the administration of Non-Emergency Medical Transportation (NEMT) services under the New Jersey Medicaid program. The Medical Director will ensure compliance with state regulations, develop medical necessity guidelines, and serve as a liaison between healthcare providers, beneficiary organizations, and internal teams. The ideal candidate will have strong Medicaid experience, expertise in utilization review, and a collaborative approach to improving access to care.

This position is contingent on award of contract.

What you’ll do:

• Ensure NEMT services meet medical necessity and coverage requirements under NJ Medicaid guidelines

• Review and approve medical policies related to transportation eligibility and utilization

• Develop and maintain coverage and medical necessity policies in alignment with state and federal regulations

• Collaborate with internal teams to implement best practices for claims processing and utilization review

• Act as a primary clinical liaison with physician groups, beneficiary organizations, and regulatory agencies

• Provide public relations support and represent the organization in meetings with healthcare providers and community partners

• Ensure adherence to NJ Medicaid coverage and payment rules

• Monitor and evaluate clinical processes for efficiency and compliance

What you’ll need:

Experience, Education & Certifications:

• Licensed physician (MD/DO), registered nurse (RN), or nurse practitioner (NP) in the State of New Jersey with an active, unrestricted license

• Relevant Medicaid experience within the health insurance industry

• Strong understanding of NJ Medicaid programs, coverage, and payment rules

• Minimum of 3 years of experience with a utilization review firm or health care claims processing organization

• Experience developing coverage or medical necessity policies and guidelines

• Public relations experience, particularly with physician groups and beneficiary organizations

Skills:

• Excellent communication and interpersonal skills

• Strong analytical and problem-solving abilities

• Ability to work collaboratively across clinical and operational teams

• Knowledge of healthcare compliance and regulatory requirements

• Experience handling sensitive and confidential information (HIPAA, PHI)

What’s in it for you:

• Health and Life Insurance Plans
• Dental and Vision Plans
• 401(k) with a company match
• Paid Time Off and Holiday Pay
• Maternity/Paternity Leave
• Casual Dress Environment
• Tuition Reimbursement
• MTM Perks Discount Program
• Leadership Mentoring Opportunities

Salary Min: $45/HR

Salary Max: $80/HR

Equal Opportunity Employer: MTM is an equal opportunity employer. MTM considers qualified candidates with a criminal history in a manner consistent with the requirements of applicable local, State, and Federal law. If you are in need of accommodations, please contact MTM’s People & Culture.

#MTM