Remote Medical Policy & Operations Director

Ladders; United States; Remote; USD 174,000 - 375,000; Full time

Benefits offered by this job

Comprehensive medical, dental, and/or视

Paid time off to support work-life

Job summary

Ladders seeks a Medical Director (Medical Policy & Operations) to provide clinical leadership at the intersection of medical policy, claims operations, and payment integrity. This remote role targets US-based candidates and focuses on improving the quality and consistency of medical care delivery.

Work with cross-functional teams to evaluate reviews, support policy decisions, and strengthen reimbursement practices through sound clinical judgment.

Qualifications

• MD or DO with ABMS board certification in an ABMS-recognized specialty.
• Active and current state medical license without encumbrances.
• Post-graduate direct patient care experience.
• Five or more years in a health care delivery system, including clinical practice.
• At least one year of experience in a health insurance company.

Responsibilities

• Provide clinical expertise to enhance quality medical care delivery
• Conduct transactional reviews for appeals and clinical claim processes
• Apply clinical coding and reimbursement expertise to align with medical policies
• Use data analysis to identify quality improvement opportunities
• Serve as a subject matter expert and internal consultant on payment policy
• Collaborate with diverse teams to achieve business objectives

Education

MD or DO with ABMS-board certification

Job description

Ladders seeks a Medical Director (Medical Policy & Operations) to provide clinical leadership at the intersection of medical policy, claims operations, and payment integrity. This remote role targets US-based candidates and focuses on improving the quality and consistency of medical care delivery.

Work with cross-functional teams to evaluate reviews, support policy decisions, and strengthen reimbursement practices through sound clinical judgment.