Clinical Medical Director (Healthcare)

TL;DR

Clinical Medical Director (Healthcare): Serving as the final clinical authority for CMS program medical review determinations with an accent on clinical quality oversight and legal defense of decisions. Focus on representing the program at Administrative Law Judge (ALJ) hearings and interpreting Medicare coverage policies.

Location: Hybrid (Atlanta, Georgia). Must be licensed to practice medicine in the United States.

Company

hirify.global is a data-centric healthcare transformation company focusing on elevating health outcomes through quality data and clinical expertise.

What you will do

• Serve as the final clinical authority for complex medical review determinations across the CMS program.
• Represent the program at ALJ hearings, testifying and defending clinical review decisions (minimum 10 appearances per month).
• Lead Discussion and Education (D&E) sessions for providers escalating disputes to the physician level.
• Provide clinical oversight and quality assurance to ensure determinations are consistent, well-documented, and defensible.
• Engage with CMS on policy interpretation, issue resolution, and emerging coverage questions.
• Collaborate with Project Managers and legal counsel to ensure the integrity and defensibility of program determinations.

Requirements

• MD or DO degree with board certification in a relevant specialty.
• Active medical license in the United States.
• Minimum 3 years of active medical practice experience post-residency.
• Background in health insurance, utilization review, or healthcare claims processing.
• Ability to maintain consistent hands-on participation in medical review activities and CMS-directed meetings.

Nice to have

• Prior experience as a Contractor Medical Director for a CMS review contractor.
• In-depth familiarity with Medicare coverage policy (NCDs, LCDs, and IOM 100-8).
• Experience leading ALJ hearing representation and preparing written testimony.
• Multi-state medical licensure.

Culture & Benefits

• Purpose-driven culture with straightforward communication and clinical domain expertise.
• Focus on data-centric transformation and efficiency in healthcare delivery.
• Hybrid work environment (office/remote).
• Equal opportunity employer with merit-based personnel processes.