Medical Director (Outpatient Medicare)

Location: Remote nationwide within the United States; occasional travel to hirify.global offices for training or meetings may be required. Typical hours are Monday–Friday, 8 hours per day, 5 days per week.

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

Company

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

What you will do

• Review moderately complex to complex outpatient authorization requests, medical necessity, level of care, and site-of-service decisions.
• Apply CMS policies, Medicare and Medicare Advantage guidelines, national clinical criteria, hirify.global policies, and contractual requirements.
• Evaluate clinical documentation and records to make accurate, evidence-based coverage determinations within required turnaround times.
• Communicate determinations and collaborate with external physicians on additional information, peer-to-peer reviews, and adverse determination discussions.
• Support care management, quality outcomes, care coordination, coding, clinical documentation, grievances, appeals, and outpatient equipment reviews.
• Collaborate with physicians, provider groups, facilities, community organizations, and internal leadership on value-based care and population health initiatives.

Requirements

• MD or DO degree.
• 5+ years of direct clinical patient care experience after residency or fellowship, preferably including outpatient care or Medicare-age and 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 communication, analytical, interpretive, clinical judgment, adaptability, and decision-making skills.

Nice to have

• Managed care, Medicare Advantage, Managed Medicaid, or utilization management experience.
• Experience applying MCG or InterQual clinical guidelines.
• Advanced degree such as an MBA, MHA, or MPH.
• Exposure to public health, population health, analytics, business metrics, social determinants of health, and complex case management.

Culture & Benefits

• Remote work with occasional office travel for training or meetings.
• Structured environment with mentored training and independent work after onboarding.
• Medical, dental, and vision benefits.
• 401(k), paid time off, company and personal holidays, paid parental and caregiver leave, disability coverage, and life insurance.
• Dedicated, interruption-free home workspace and internet service with at least 25 Mbps download and 10 Mbps upload required to protect member PHI and HIPAA information.

Hiring process

• Application prescreen followed by an approximately 10–15-minute on-demand HireVue assessment with predetermined questions.
• Successful candidates proceed to subsequent interview rounds.
• SSN entry in Workday is requested only after a formal employment offer to check for duplicate profiles.