Remote Medical Policy Director for Health Plan Strategy

Cotiviti; United States; Remote; USD 225,000 - 275,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

Disability insurance

Life insurance

401(k) plan

Paid time off (PTO)

Paid holidays

Job summary

Cotiviti seeks a Client Medical Director to lead medical policy and payment integrity initiatives for a major health plan. This role collaborates with the Go To Market team, reviews client data, selects policy opportunities, and serves as the clinical SME for policy edits and coding discussions.

The CMD will foster client trust, support sales opportunities, and act as a strategic advisor on medical payment policy while working from a remote location within the continental U.S.

Qualifications

• Licensed MD/DO with clinical and health plan experience.
• Experience in Health plan operations as a Medical Director with focus on medical policy, medical coding, payment integrity and/or fraud/waste/abuse.
• Adaptive capacity for rapidly changing priorities and workloads, multitasking, prioritizing and meeting deadlines.

Responsibilities

• Supporting existing client growth and new sales activity by identifying value-creation opportunities for our clients.
• Presents appropriate payment policy to clients for adoption based on review of data analytics.
• Defines mission and strategy with Client Engagement Leader; delivers strategy to client’s medical policy team.
• Works alongside Medical Policy team to evaluate and validate editing.
• Acts as a clinical liaison with our health plan clients.
• Lend guidance to the research & development efforts of our Medical Policy and Solutions teams.
• Have in-depth knowledge of claims, claims adjudication, medical policy edits and configurations.
• Inspire trust and credibility, deliver on commitments, provide value-add analytics.
• Assist in discovering opportunities for other Cotiviti product sales.
• Other duties as assigned.

Skills

Medical policy expertise

Clinical medicine

Health plan operations

Presentation skills

Analytical thinking

Microsoft Office

Education

MD/DO medical degree

Tools

None

Job description

Cotiviti seeks a Client Medical Director to lead medical policy and payment integrity initiatives for a major health plan. This role collaborates with the Go To Market team, reviews client data, selects policy opportunities, and serves as the clinical SME for policy edits and coding discussions.

The CMD will foster client trust, support sales opportunities, and act as a strategic advisor on medical payment policy while working from a remote location within the continental U.S.