Physical Health Medical Director (Medicaid)

Location: Remote within one of the assigned cluster states: Indiana, Ohio, Kentucky, Virginia, Wisconsin, or Illinois. Occasional travel to hirify.global offices for training or meetings may be required.

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 and Medicaid members through insurance and healthcare services.

What you will do

• Review clinical records and determine whether requested services, levels of care, and sites of service should be authorized.
• Apply Medicaid requirements, state policies, CMS policies, national clinical guidelines, and internal clinical resources.
• Prioritize complex outpatient and inpatient clinical scenarios and communicate determinations to internal associates.
• Conduct physician-to-physician discussions, gather additional clinical information, and resolve conflicts during peer-to-peer reviews.
• Collaborate with physicians, provider groups, facilities, and community organizations on regional priorities, value-based care, population health, and care management.
• Provide coverage across the assigned cluster during vacations, weekends, and holidays as needed.

Requirements

• Doctor of Medicine or Doctor of Osteopathy degree and board certification in an ABMS- or ABPN-recognized specialty.
• At least five years of clinical experience after completion of training.
• Current unrestricted medical licensure in at least one state within the assigned cluster, with the ability to obtain additional required state licenses.
• Experience in utilization management review, case management, and working with Medicaid enrollees, providers, and stakeholders.
• Experience with NCQA accreditation processes, CGX, and MHK.
• Interstate Medical Licensure Compact licensure, successful credentialing, and no current federal or state government sanctions.
• Ability to meet onboarding requirements and maintain a dedicated workspace protecting member PHI and HIPAA information.

Culture & Benefits

• Remote work with occasional office travel for training or meetings.
• Dedicated home workspace and internet service with at least 25 Mbps download and 10 Mbps upload speeds.
• Medical, dental, and vision benefits.
• 401(k) retirement savings plan, paid time off, company and personal holidays, and paid parental and caregiver leave.
• Short- and long-term disability, life insurance, wellness support, and additional benefits.