Senior Payment Integrity Physician Reviewer

Clearlink Partners; United States; On-site; USD 138,000 - 207,000; Full time

Job summary

Clearlink Partners in the United States seeks a senior health care consultant with MD/DO licensing to guide payment integrity and medical management strategies for managed care clients. You will lead engagements, translate clinical and financial data into actionable plans, and present findings to client executives.

This role requires deep managed care expertise, regulatory acumen, and strong leadership across cross-functional teams.

Qualifications

• MD/DO physician licensed and board certified is required.
• Extensive knowledge of managed care policies and regulatory frameworks.
• Experience translating strategy into scalable healthcare programs.
• Strong leadership and cross-functional collaboration skills.

Responsibilities

• Provide strategic direction for health plan medical management and operations.
• Lead client engagements and deliver value through innovative solutions.
• Present findings and recommendations to client executives.
• Translate clinical, operational, and financial results into actionable plans.
• Coach staff and manage multiple complex projects concurrently.
• Ensure compliance with healthcare regulations and contractual terms.

Skills

Managed care

Strategic leadership

Regulatory compliance

CMS/NCQA knowledge

Education

Medical Degree (MD/DO)

Tools

Excel

Word

PowerPoint

Visio

Job description

Clearlink Partners in the United States seeks a senior health care consultant with MD/DO licensing to guide payment integrity and medical management strategies for managed care clients. You will lead engagements, translate clinical and financial data into actionable plans, and present findings to client executives.

This role requires deep managed care expertise, regulatory acumen, and strong leadership across cross-functional teams.