Research Medical Director (Medicaid Medical Policy)

New

CotivitiMedicaid medical policy

This is a full-time role and can work remotely in the US.Full-TimeDirector

SalaryBase compensation ranges from $225,000 to $275,000 per year. This role is eligible for discretionary bonus consideration.

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Job Details

United States MD or DO degree required.
10+ years of research experience.
Experience working with a Medicaid payer preferred.
MBA degree preferred.
Knowledge of healthcare payers, payment policy, and correct coding preferred.
In-depth knowledge of claims, claims adjudication, medical policy rules, and edits.
Strong organizational and project management experience preferred.
Proven success as a manager in a scalable organization with significant scope, complexity, and breadth.
Ability to lead and manage in a matrix environment and achieve results through others.
Ability to work independently and in a team, prioritize multiple tasks, and meet deadlines.
Must provide a dedicated, secure work area and high-speed internet access, connectivity, and office setup.

Interpret payment policy and medical coding information and guidelines against the policy library.
Research and analyze medical policy items and perform data and report analysis.
Translate industry references into company policy.
Review and update medical policies to keep the policy library accurate and current.
Assess research inquiries and use clinical judgment to determine their potential impact on medical policies.
Determine whether changes in the industry warrant updates to policy logic or content.
Perform quality assurance on policy reviews, logic revisions, and research requests, and provide feedback to originators.
Educate client-facing MDs and Client Policy Managers on policy changes and updates in monthly meetings.
Document notable changes and complete work accurately and on time.

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