Executive Medical Director DME/HH

Location: United States Work at Home. Home internet must use cable broadband or fiber optic service with at least 10 Mbps download and 5 Mbps upload speeds.

Annual salary: USD 238,100–396,800, depending on experience and geographic location. Eligible for an annual bonus and long-term incentive plan.

Company

Evernorth Health Services, a division of hirify.global, develops pharmacy, care, and benefit solutions designed to improve health and make treatment more accessible.

What you will do

• Lead the clinical management of EviCore’s Durable Medical Equipment and Home Health programs.
• Create, maintain, and review clinical guidelines, policies, denial rationales, pathways, and certification criteria.
• Provide expert medical review for urgent, expedited, escalated, appeal, peer-to-peer, and post-decision cases.
• Support Medicare and Medicaid audits, client audits, case discussions, complaints, amendments, and ALJ hearings.
• Supervise, coach, mentor, train, and evaluate Medical Directors and Associate Medical Directors.
• Collaborate with clinical, non-clinical, program operations, sales, and client management leadership to improve program performance.

Requirements

• M.D. or D.O. degree from an accredited institution.
• At least five years of clinical practice after completing residency and fellowship, when applicable.
• Active, unrestricted U.S. medical license required for utilization review practice.
• At least two years of managed care experience.
• Knowledge of applicable state and federal laws, URAC and NCQA standards, and utilization management.
• Familiarity with automated processes, computer applications, and systems; supervisory or management experience is strongly preferred.

Nice to have

• Active board certification in Physical Medicine & Rehabilitation.
• Supervisory or management experience.

Culture & Benefits

• Remote work arrangement with required high-speed cable or fiber internet.
• Medical, vision, dental, well-being, and behavioral health benefits from the first day of employment.
• 401(k), company-paid life insurance, tuition reimbursement, paid holidays, and leaves of absence.
• At least 18 days of paid time off per year.
• Participation in required educational and quality improvement activities.