Medical Director (Medicare Pharmacy)

Location: Remote nationwide within the United States; occasional travel to hirify.global offices for training or meetings may be required.

Salary: $223,800–$313,100 per year full-time equivalent; this part-time seasonal role is compensated hourly and is non-benefited.

Company

hirify.global is a U.S. healthcare and insurance company serving Medicare, Medicaid, individual, family, military, and community populations through hirify.global and CenterWell services.

What you will do

• Review Medicare Part D and Part B drug appeals, including moderately complex to complex coverage cases.
• Evaluate medical necessity using Medicare rules, hirify.global policies, CMS guidance, coverage determinations, recognized compendia, clinical guidelines, and literature.
• Apply Medicare Part D and Medicare Advantage requirements in daily medical-management work.
• Collaborate with clinicians and support staff to provide value-based care.
• Support additional responsibilities related to regulatory compliance and hirify.global policy.

Requirements

• MD or DO degree.
• Current, unrestricted medical license in at least one jurisdiction and willingness to obtain additional licenses if required.
• Current and ongoing board certification, preferably in Internal Medicine, Family Medicine, Emergency Medicine, or Physical Medicine and Rehabilitation.
• No current federal or state government sanctions and ability to pass credentialing requirements.
• Strong verbal and written communication, analytical, and interpretation skills.
• Prior participation in quality management, utilization management, or similar activities.

Nice to have

• Managed care, integrated delivery systems, health insurance, or clinical group practice management experience.
• Utilization-management experience with Medicare Advantage, managed Medicaid, or commercial health insurance.
• 5+ years of direct clinical patient-care experience after residency or fellowship, preferably with Medicare-age or disabled populations.
• Experience with guidelines and resources such as MCG, InterQual, NCCN, Micromedex, Lexicomp, or Clinical Pharmacology.
• Exposure to public health, population health, analytics, business metrics, and collaborative team environments.

Culture & Benefits

• Part-time, seasonal position with variable and flexible weekly hours.
• Work from home requires a dedicated, interruption-free workspace to protect member PHI and HIPAA information.
• Home internet must provide at least 25 Mbps download and 10 Mbps upload speeds.
• hirify.global provides appropriate telephone equipment; internet-expense payments are available for eligible home-based employees in California, Illinois, Montana, and South Dakota.
• Limited-term, variable-schedule, and per-diem associates may receive paid time off, 401(k), employee assistance, and business travel and accident benefits.