Medical Director

Overview The Client Medical Director (CMD) is a key member of the Go To Market team. Along with the Client Engagement Leader, the CMD co‑captains the team serving the Prospective Payment Management (PPM) client team at the health plan. The CMD’s role is to serve as a coding and medical payment policy subject matter expert (SME). The CMD is responsible for directing the Medical Policy Committee (joint committee with health plan MD, coding experts, and payment integrity). The CMD will develop a relationship with the client, review their data, select medical policy to present, serve as SME for clinical and coding expertise, and provide back‑end support for the client’s Medical Director. The CMD will evolve as the trusted advisor for the health plan in terms of medical payment policy. 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. Qualifications Minimum Qualifications: Licensed MD/DO with clinical and health plan experience. Position Requirements: Experience in health‑plan operations as a Medical Director, focusing on medical policy, medical coding, payment integrity and/or fraud/waste/abuse. Experience in clinical medicine. Adaptive capacity for rapidly changing priorities and workloads, multitasking, prioritizing and meeting deadlines. Client relationship skills – ability to develop strong professional relationships with multiple roles and levels. Comfortable with presenting to small and large groups of people. Strong organizational, analytical and problem‑solving skills. Results driven with focus on producing high‑quality, error‑free service and deliverables. Ability to work well independently and in a team environment. Excellent verbal and written communication skills. Proficient with Microsoft Office Suite (Word, Excel, PowerPoint); advanced Excel proficiency preferred. Exhibits behaviors consistent with Cotiviti values. Job Demands: The role can work at home anywhere in the continental United States (some travel is required ~10%). Able to use computer keyboard for extended periods of time. After hours and/or weekend work may be required where necessary for major deliverables /deadlines. Mental Requirements: Communicating with others to exchange information. Assessing the accuracy, neatness, and thoroughness of the work assigned. Physical Requirements and Working Conditions: Remaining in a stationary position, often standing or sitting for prolonged periods. Repeating motions that may include the wrists, hands, and/or fingers. Must be able to provide a dedicated, secure work area. Must be able to provide high‑speed internet access/connectivity and office setup and maintenance. No adverse environmental conditions expected. Compensation & Benefits Base compensation ranges from $200,000 to $275,000 per year. Specific offers are determined by various factors, such as experience, education, skills, certifications, and other business needs. This role is eligible for discretionary bonus consideration. Cotiviti offers team members a competitive benefits package to address a wide range of personal and family needs, including medical, dental, vision, disability, and life insurance coverage, 401(k) savings plans, paid family leave, 9 paid holidays per year, and 17‑27 days of Paid Time Off (PTO) per year, depending on specific level and length of service with Cotiviti. #J-18808-Ljbffr