Market Medical Officer (Health Insurance)

Location: Fully remote within the U.S., excluding Alaska, Delaware, Hawaii, Louisiana, Montana, North Dakota, Oklahoma, West Virginia, Wyoming, and U.S. territories. Daily work is completed from a home office, with occasional travel for team meetings and company events.

Base pay: $290,628–$381,449 per year in California, Connecticut, New Jersey, New York, and Washington; $261,565–$343,304 per year in other locations.

Company

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

What you will do

• Lead clinical performance and medical cost trend management for health plans in the Atlantic region.
• Analyze utilization trends with Medical Economics and develop solutions to reduce overall healthcare spend.
• Build partnerships with health systems, physician groups, and community providers to align incentives and lower the total cost of care.
• Collaborate with Affordability, Utilization Management, Care Management, Claims, and Network Contracting teams on regional performance goals.
• Identify and resolve network gaps and access barriers while advancing care quality and clinical outcomes.
• Manage regional escalations, appeals, grievances, complex cases, regulatory requirements, and network adequacy programs.

Requirements

• 12+ years of progressive healthcare leadership experience and 10+ years of managed care experience in a matrix environment.
• At least 7 years of clinical leadership in the relevant market and 7+ years managing clinical market trends in health insurance or full-risk provider groups.
• At least 5 years of clinical practice, board certification, and 5+ years leading teams.
• MD or DO with a current unrestricted medical license required in Georgia, North Carolina, South Carolina, New Jersey, New York, Pennsylvania, or Virginia.
• Must reside in an eligible U.S. location; candidates in the listed excluded states and U.S. territories are not eligible.
• Active board certification and willingness to obtain additional state licenses are required.

Nice to have

• P&L experience for a risk-bearing entity.
• Licensure in multiple Oscar states.
• Master’s degree or advanced certificate.
• Prior Utilization Management experience.

Culture & Benefits

• Fully remote work from a home office with occasional travel for meetings and company events.
• Medical, dental, and vision benefits.
• Unlimited vacation program, paid holidays, paid sick time, parental leave, and paid wellness time.
• 401(k) participation, life and disability insurance, wellness reimbursements, equity grants, and annual performance bonuses.
• Equal opportunity environment focused on belonging and support.