Remote Medical Director, Marketplace

Location: Remote-MO; current unrestricted MD or DO license required

Salary: $236,500–$449,300 per year

Company

hirify.global is a diversified national healthcare organization serving 28 million members.

What you will do

• Assist the Chief Medical Director in directing medical management, utilization management, quality improvement, and credentialing functions.
• Lead utilization review, cost-containment, quality improvement, and medical necessity reviews for complex, controversial, experimental, unusual, or new services.
• Coordinate care for high-risk patients and collaborate with care management teams, providers, appeals teams, and medical and pharmacy consultants.
• Support performance improvement initiatives for capitated providers and develop physician education on clinical policies and issues.
• Identify utilization and clinical quality studies, adverse trends, unusual provider patterns, and opportunities to reduce unwarranted variation.
• Support physician committees, provider network development, market expansion, and representation before state or other committees.

Requirements

• Medical Doctor or Doctor of Osteopathy degree.
• Active medical practice and board certification in a specialty recognized by the American Board of Medical Specialists or the American Osteopathic Association’s Department of Certifying Board Services.
• Current state MD or DO license without restrictions, limitations, or sanctions from government programs.
• Utilization management experience and knowledge of quality accreditation standards are preferred.
• Internal or family medicine certification and experience with culturally diverse populations are preferred.
• Coursework in health administration, health financing, insurance, or personnel management is advantageous.

Culture & Benefits

• Remote work arrangement with a flexible approach to remote, hybrid, field, or office schedules.
• Health insurance, 401(k), stock purchase plans, tuition reimbursement, paid time off, and holidays.
• Weekend and holiday work may be required to support business operations.
• Compensation is adjusted based on skills, experience, education, job-related factors, and employment status.