Medical Director: MD or DO Required

Location: Remote or hybrid for candidates living in Florida, Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota, or Texas. Depending on the assignment, the role may need to be completed in Nebraska.

Company

hirify.global is a health insurance organization focused on member and community health and well-being.

What you will do

• Lead medical management strategies that improve practice transformation, patient satisfaction, quality outcomes, and healthcare cost management.
• Provide clinical oversight for utilization review, quality assurance, case management, population health, and cost management activities.
• Conduct evidence-based medical necessity reviews for prior authorization, utilization management appeals, claim determinations, and related cases.
• Provide clinical, coding, reimbursement, and business expertise to medical management programs and policy activities.
• Conduct peer-to-peer conversations with attending and ordering physicians while supporting timely responses to members and providers.
• Build relationships with clinicians and partners, analyze clinical workflows, and support interventions that improve quality and reduce unplanned healthcare utilization.

Requirements

• Doctor of Medicine (M.D.) or Doctor of Osteopathic Medicine (D.O.).
• Seven years of experience in a healthcare delivery system, including clinical practice or healthcare industry experience.
• Board certification through an American Board of Medical Specialties board.
• Active, current, and unrestricted U.S. medical license, including an active, current, and unrestricted Nebraska clinical license.
• Three years of direct clinical care experience in private or academic practice, including postgraduate direct patient care.
• Ability to meet department attendance and timeliness requirements and build effective relationships in a team environment.

Nice to have

• Two or more years of managed care experience, preferably with a Medicare Advantage population.
• Experience creating buy-in among internal and external clinician stakeholders to transform clinical care.

Culture & Benefits

• Mission-driven work focused on improving member and community health.
• Remote and hybrid work options are available within the listed U.S. states.
• Opportunities to contribute to clinical policy, medical management, and quality improvement initiatives.
• Reasonable accommodations are available to enable individuals with disabilities to perform essential functions.