Medical Director-Payment Integrity

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, plus eligibility for a bonus incentive plan.

Company

hirify.global is a U.S. healthcare company providing insurance and healthcare services for Medicare, Medicaid, families, individuals, military personnel, and communities.

What you will do

• Review inpatient and post-acute clinical records and determine whether requested services, care levels, and sites of service meet national guidelines, CMS requirements, hirify.global policies, and clinical standards.
• Conduct post-service inpatient care reviews to validate diagnoses, services received, and billing accuracy.
• Analyze moderately complex to complex clinical scenarios and prioritize daily review work.
• Communicate medical determinations to internal associates and participate in peer-to-peer discussions with external providers when needed.
• Support disputes, grievances, appeals, project teams, organizational committees, and market-wide objectives.
• Collaborate with other departments, clinical colleagues, and the Lead Medical Director while working independently after mentored training.

Requirements

• MD or DO degree.
• At least 5 years of direct clinical patient care experience after residency or fellowship, preferably including inpatient care or experience with Medicare-age or disabled populations.
• Current and ongoing board certification in an approved ABMS medical specialty.
• Current unrestricted medical license in at least one jurisdiction and willingness to obtain additional licenses if required.
• No current federal or state government sanctions and ability to pass credentialing requirements.
• Strong verbal and written communication, analytical, interpretation, quality management, utilization management, case management, discharge planning, or post-acute care experience.

Nice to have

• Knowledge of Medicare Advantage, managed Medicaid, commercial insurance, managed care, hospitals, integrated delivery systems, or clinical group practice management.
• Utilization management experience in a medical management review organization.
• Experience with national guidelines such as MCG or InterQual.
• Specialization in internal medicine, hospitalist medicine, family practice, geriatrics, or emergency medicine.
• Advanced degree such as an MBA, MHA, or MPH, with exposure to public health, population health, analytics, or business metrics.

Culture & Benefits

• Full-time schedule of 40 hours per week in a remote work-from-home role.
• Dedicated interruption-free workspace and reliable internet connection with at least 25 Mbps download and 10 Mbps upload speeds are required to protect member PHI and HIPAA information.
• Medical, dental, and vision coverage, 401(k) retirement savings, paid time off, company and personal holidays, and paid parental and caregiver leave.
• Short- and long-term disability coverage, life insurance, and additional wellness and healthcare benefits.
• Work is performed in a structured environment with emphasis on consistency, independent judgment, adaptability, and innovation.