Medical Director (Outpatient Medicare)

Location: Fully remote in the United States; 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 providing medical and healthcare services to Medicare, Medicaid, individual, military, and community populations.

What you will do

• Review health claims, clinical documentation, and complex clinical scenarios, primarily involving inpatient and post-acute care.
• Determine medical necessity and authorize requested services, levels of care, and sites of service.
• Apply national clinical guidelines, CMS policies, Medicare Advantage requirements, and internal policies to utilization management decisions.
• Communicate determinations to internal associates and conduct peer-to-peer discussions with external physicians.
• Support grievance and appeals reviews, coding and clinical documentation oversight, and care management activities.
• Collaborate with care management, regional leadership, physicians, facilities, and community partners on value-based care and population health initiatives.

Requirements

• MD or DO degree and current, ongoing board certification in an ABMS-approved medical specialty.
• At least 5 years of direct clinical patient care experience after residency or fellowship.
• Current and unrestricted medical license in at least one jurisdiction, with willingness to obtain additional licenses when required.
• No current sanctions from federal or state governmental organizations and ability to pass credentialing requirements.
• Strong verbal and written communication, analytical, interpretation, and conflict-resolution skills.
• Experience with quality management, utilization management, case management, discharge planning, home health, or post-acute services is required.

Nice to have

• Specialty experience in pulmonology, sleep medicine, cardiology, general surgery, radiology, interventional radiology, or genetics.
• Knowledge of managed care, Medicare Advantage, Managed Medicaid, or commercial health insurance.
• Utilization management experience and familiarity with MCG or InterQual guidelines.
• Advanced degree such as an MBA, MHA, or MPH.
• Experience in population health, analytics, business metrics, complex case management, or social determinants of health.

Culture & Benefits

• Full-time schedule of 40 hours per week, typically Monday through Friday during business hours.
• Some flexibility in working hours may be available based on business needs.
• Medical, dental, and vision insurance, 401(k), paid time off, holidays, and paid parental and caregiver leave.
• Short- and long-term disability insurance, life insurance, and additional wellness and healthcare benefits.
• Dedicated, interruption-free home workspace and internet service with at least 25 Mbps download and 10 Mbps upload speeds are required.

Hiring process

• Selected candidates complete a 10–15-minute on-demand assessment through HireVue.
• Candidates advancing past the assessment proceed to additional interviews.
• After a formal offer, an SSN entry request is sent through Workday for duplicate-profile screening.