Senior Medical Director (AI)

TL;DR

Senior Medical Director (AI): Providing strategic clinical leadership for the development and validation of AI-driven pre-payment edits with an accent on payment integrity and medical necessity reviews. Focus on acting as a trusted advisor to executive leadership and external stakeholders while ensuring clinical strategies align with evolving healthcare regulations and industry best practices.

Location: Remote (US)

Salary: $211,551–$317,326

Company

An AI-first healthcare technology company dedicated to simplifying the business of care by preventing inaccurate payments and reducing waste in the healthcare ecosystem.

What you will do

• Assist the Clinical Development Department with the creation, maintenance, and communication of new pre-payment edits.
• Provide clinical rationale for editing concepts and support the Product Strategy team in content group management.
• Analyze clinical content and rules to identify trends and opportunities for new content development.
• Serve as a trusted advisor to internal stakeholders and external clients regarding healthcare trends and competitive product offerings.
• Represent the organization in industry forums and facilitate webinars for client Medical Directors.
• Engage in regular interactions with executives and customers, including occasional on-site visits.

Requirements

• Board-certified physician (MD or DO) with at least 10 years of active clinical experience.
• 3+ years of experience as a Medical Director for a health insurance payer.
• AAPC (CPC) or AHIMA (CCS-P) certification required or within 6 months of hire.
• Deep understanding of disease processes, evidence-based medicine, and payer operations.
• Proven leadership in clinical and cross-functional teams.
• Strong critical thinking and strategic planning skills with the ability to analyze complex claims data.

Culture & Benefits

• Commitment to an inclusive environment and collaborative success.
• Opportunity to shape the future of healthcare innovation using AI.
• Recognition as a 2025 Best in KLAS for Pre-Payment Accuracy and Integrity.
• HI-TRUST and SOC2 certified organization.
• Focus on professional growth and industry leadership.