Medical Director

MTM, Inc; Trenton (NJ); On-site; USD 62,000 - 110,000; Full time

Benefits offered by this job

Health Insurance

Dental and Vision Plans

401(k) with company match

Paid Time Off and Holidays

Maternity/Paternity Leave

Casual Dress Environment

Tuition Reimbursement

MTM Perks Discount Program

Leadership Mentoring Opportunities

Job summary

MTM Health seeks a qualified Medical Director to provide clinical oversight for NJ Non-Emergency Medical Transportation under Medicaid rules.

Lead medical necessity policies, collaborate with providers and internal teams, and ensure compliance with state/federal regulations.

The role emphasizes utilization review, public relations with physician groups, and ongoing process improvement.

Qualifications

• Licensed physician (MD/DO), RN, or NP in NJ with active license.
• Strong Medicaid experience within health insurance.
• Knowledge of NJ Medicaid programs, coverage, and payment rules.
• At least 3 years with a utilization review firm or claims processing organization.
• Experience developing coverage or medical necessity policies.
• Public relations experience with physician groups and beneficiary organizations.

Responsibilities

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

Skills

Medical licensure

Medicaid experience

Utilization review

Policy development

Public relations

Team collaboration

Education

MD/DO or RN/NP license

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:

• 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.

About Us

MTM Health is a healthcare and transportation management company whose mission is to partner with clients in developing innovative solutions for accessing healthcare, increasing independence, and connecting community resources in the most cost-effective manner. To achieve this, we leverage our core competencies in managing customer service operations and building provider networks.

• Respect Individuals
• Collaborate to Innovate
• Deliver Value
• Align with Clients
• Act with Integrity

Your Potential. Our Mission. At MTM Health, you're not just part of a team—you’re at the heart of a movement to remove community barriers nationwide. We're all about breaking the mold with bold ideas, open conversations, and a relentless focus on what matters most: you. Here, collaboration sparks breakthroughs, learning fuels growth, and every voice shapes our future. Together, we thrive, push our limits, and work as team to help you reach your full potential.

With consistent Top Workplace and Best Place to Work awards, plus honors for Healthiest Employers, Diversity and Inclusion, Women in Leadership, and top-tier training programs, we’re recognized for creating a culture that empowers you to thrive, innovate, and lead with impact.

Benefits without Barriers To show appreciation for our staff’s hard work and dedication, MTM offers more than just a paycheck. Our Total Rewards program is all encompassing, offering a wide variety of enticing benefits to ensure our employees and their families are rewarded.

Limitless Growth Opportunities At MTM, your growth powers our movement. Our career development programs are designed to ignite your potential, sharpen your skills, and propel you toward a future where you don't just succeed—you redefine what's possible.

• Art of Client Communication
• Cornerstone Program
• Bench Program
• Tech Bench Program
• Continuous Education Reimbursement