Associate Medical Director, Regulatory Management (Healthcare)

Location: Fully remote, open only to candidates residing in Atlanta, Georgia, United States. The role may potentially transition to a hybrid model at the metro-area hub in the future.

Salary: $216,108–$283,642 per year, plus performance bonuses and employee benefits.

Company

hirify.global is a health insurance company built around a full-stack technology platform and focused on improving the member experience.

What you will do

• Lead the Clinical Policy Compliance team and Clinical Coding Center of Excellence.
• Develop clinical regulatory policies, Benefit Interpretation Policies, and operational SOPs aligned with state and federal requirements.
• Chair the Credentialing, Peer Review, and Population Health Management subcommittee and report performance metrics to Quality Improvement meetings.
• Oversee practitioner and facility credentialing, including license, board certification, and sanction-history verification.
• Partner with Network and Market Management to accelerate provider onboarding and resolve network gaps.
• Improve clinical review operations, delegate audits, inter-rater reliability processes, Potential Quality Issue workflows, and regulatory change implementation.

Requirements

• 7+ years of progressive healthcare experience, including leadership responsibility.
• 3+ years managing provider credentialing in a health plan, managed care organization, or large healthcare system.
• Knowledge of NCQA credentialing standards, CMS health plan requirements, and applicable federal and state regulations.
• At least 1 year of experience managing and working with clinical coding taxonomies.
• Experience leading operational improvement initiatives, cross-functional partnerships, provider data management, credentialing systems, and primary source verification.
• MD or DO with a current unrestricted medical license required; active board certification must be maintained. Willingness to obtain additional state licensure is required.

Nice to have

• Licensure in multiple Oscar states.
• Master’s degree or advanced certificate.
• Prior utilization management experience.

Culture & Benefits

• Unlimited vacation program and annual performance bonuses.
• Medical, dental, and vision benefits.
• 11 paid holidays, paid sick time, paid parental leave, and paid wellness time.
• 401(k) participation, life and disability insurance, and wellness reimbursements.
• Equal opportunity environment focused on belonging and authentic participation.