Medical Director (Healthcare)

Location: United States Work at Home

Salary: $212,600–$354,300 USD annually, depending on experience and geographic location; eligible for an annual bonus and long-term incentive plan.

Company

hirify.global provides healthcare and health services through Cigna Healthcare and Evernorth Health Services, focusing on improving the health and vitality of clients, customers, and patients.

What you will do

• Perform benefit-driven medical necessity reviews for coverage, case management, and claims resolution using clinical guidelines, benefit plans, and applicable regulations.
• Provide clinical consultation and peer review across medical and behavioral health conditions, treatments, and procedures.
• Support appeals, coverage guideline development, medical management projects, audits, quality reviews, and regulatory initiatives.
• Improve clinical outcomes and healthcare professional relationships through education, communication, negotiation, and evidence-based guidance.
• Mentor Medical Directors and colleagues in quality and performance improvement processes.
• Investigate client and regulatory questions and maintain timely, compliant coverage decisions.

Requirements

• Current unrestricted medical license in a US state or territory.
• Current board certification in an ABMS- or AOA-recognized specialty.
• At least five years of clinical practice experience and/or direct patient care beyond residency.
• Ethical and professional conduct, strong communication, negotiation, decision-making, problem-solving, and teamwork skills.
• Competence with word processing, spreadsheets, email, PowerPoint, and personal information management tools.
• Must not be excluded from federal healthcare programs or included on CMS’ Preclusion List.

Nice to have

• Experience in medical management, utilization review, case management, or managed care.
• Knowledge of managed care products and strategies.
• Experience managing multiple projects in a fast-paced matrix environment.
• Experience educating colleagues and staff and managing organizational change.
• Service marketing, sales, and business acumen.

Culture & Benefits

• Work from home requires cable broadband or fiber internet with at least 10 Mbps download and 5 Mbps upload speeds.
• Medical, vision, dental, well-being, and behavioral health benefits begin on the first day of employment.
• 401(k), company-paid life insurance, tuition reimbursement, paid holidays, and leaves of absence.
• At least 18 days of paid time off per year.