Physical Health Medical Director (Medicaid)

Location: Fully remote within the United States, with the role based in Indiana, Ohio, Kentucky, Virginia, Wisconsin, or Illinois. Occasional travel to hirify.global hubs or offices may be required for training or meetings.

Salary: $223,800–$313,100 per year, plus eligibility for a bonus incentive plan.

Company

hirify.global is a U.S. healthcare company providing insurance and healthcare services to Medicare and Medicaid members, families, individuals, and communities.

What you will do

• Determine whether requested services, levels of care, and sites of service meet medical necessity and appropriateness standards.
• Review complex outpatient and inpatient clinical cases, documentation, and supporting records using approved clinical and regulatory resources.
• Apply Medicaid, CMS, state policy, and compliance requirements to daily utilization management decisions.
• Communicate determinations and rationale to internal associates and conduct peer-to-peer discussions with external physicians.
• Collaborate with physicians, provider groups, facilities, and community organizations to support regional market priorities.
• Contribute to care management, population health, value-based care, disease management, and cross-coverage activities.

Requirements

• Doctor of Medicine or Doctor of Osteopathy degree.
• Board certification in an ABMS-recognized specialty.
• Current, unrestricted licensure in at least one of Indiana, Ohio, Kentucky, Virginia, Wisconsin, or Illinois, with the ability to obtain required licenses in other cluster states.
• Experience working with Medicaid enrollees, providers, and stakeholders in a clinical or administrative setting.
• Experience with NCQA accreditation, CGX, MHK, utilization management review, and case management in a health plan setting.
• Ability to work regular Monday–Friday business hours, 8 hours per day, 40 hours per week, from a dedicated workspace that protects PHI and HIPAA information.

Culture & Benefits

• Fully remote work with possible flexibility based on business needs.
• Occasional travel to hirify.global offices for training or meetings.
• Medical, dental, and vision benefits.
• 401(k), paid time off, company and personal holidays, and paid parental and caregiver leave.
• Short- and long-term disability coverage, life insurance, and other well-being benefits.

Hiring process

• Applicants who pass the initial prescreen may receive an on-demand HireVue assessment.
• The assessment includes predetermined questions and takes approximately 10–15 minutes.
• Selected candidates proceed to subsequent interviews after assessment review.