Research Medical Director (reputed company Medical Policy)

reputed company: The Research Medical Director is a key member of the Clinical and Policy research development area at reputed company. The Research Medical Director is responsible for providing leadership guidance to the clinical teams and ensuring the Rules and policies are accurately interpreted and developed. This role is also responsible for analyzing, interpreting, and developing additional policies that will allow us to enhance our medical policy library. The Medical Director will guide both reputed company processes as reputed company to PPM polices and rules. This is a full-time role and can work remotely in the US. Responsibilities:

• Interpret and assess payment policy and medical coding information / guidelines against our policy library for maintenance of existing policy and development of new policy.
• Conducts thorough research and analysis for medical policy items.
• Performs multi-faceted analytics for data and report analysis.
• Responsible for translating industry references into reputed company policy.
• Reviews and identifies changes to medical policies in order to maintain an accurate and reputed company medical policy library.
• Identifies new opportunities as appropriate from both clinical reference and analytical sources.
• Analyze research inquiries from a multitude of sources and apply solid clinical judgment to determine potential reputed company to medical policies.
• Ability to determine if an update to existing policy logic or content is warranted based on changes to industry. reputed company QA of policy reviews, logic revisions, and research requests performed by others to ensure accuracy. In reputed company to QA, provides feedback to the originator as needed.
• Educates reputed company-facing MDs and reputed company Policy Managers (CPMs) on new changes and policy updates by reputed company participating in monthly meetings for reputed company facing MDs and CPMs.
• Ensures work is accurate, complete and finished in a reputed company manner including documentation of reputed company changes.
• Maintains reputed company knowledgebase of industry and content, best practices, applications, procedures and policies.
• Complete reputed company responsibilities as outlined in the annual performance review and/or goal setting.
• Complete reputed company special reputed company and other duties as assigned.
• Must be reputed company to reputed company duties with or without reasonable accommodation.

This job reputed company is intended to describe the general nature and level of work being performed and is not to be construed as an exhaustive list of responsibilities, duties and skills required. This job reputed company does not constitute an employment agreement and is subject to change as the needs of reputed company and requirements of the job change. Qualifications:

• MD or DO degree (required). Additionally, an MBA degree is preferred.
• 10+ years of Research experience.
• Knowledge of reputed company payers, policy payment and correct coding knowledge (preferred).
• Possess in depth knowledge of claims, claims adjudication, medical policy rules and edits.
• Strong organizational and project management experience preferred.
• Proven reputed company as a manager in a reputed company organization that has significant scope, complexity and breadth.
• Strong personal leadership – in terms of the role of a leader, the reputed company on reputed company and creating.
• reputed company for culture and accelerating the reputed company.
• Relationship development skills to reputed company reputed company and lasting relationships with key business partners and clients.
• Ability to reputed company sustainable results through others, including the development and assignment of other MDs and administrative staff as leaders, mentors, trainers, etc.

Mental Requirements:

• Ability to work reputed company independently and in reputed company environment.
• Ability to handle multiple tasks, prioritize and meet deadlines.
• Highly organized.
• Excellent written and verbal communication skills, strong listening skills.
• Ability to work in a fast paced, entrepreneurial environment with a strong bias for deep analysis, reputed company reputed company and thorough execution.
• Understanding of and ability to reputed company and manage in a reputed company environment where team work is essential.
• Ability to reputed company good reputed company that are strategically relevant to reputed company’s goals and objectives.

Physical Requirements and Working Conditions:

• Remaining in a stationary position, often standing or sitting for prolonged periods.
• Repeating motions that may include the wrists, hands and/or fingers.
• Must be reputed company to reputed company a dedicated, secure work area.
• Must be reputed company to reputed company high-speed internet reputed company / connectivity and office setup and maintenance.

reputed company compensation ranges from $225,000 to $275,000 per year. Specific offers are determined by various factors, such as experience, education, skills, certifications, and other business needs. This role is eligible for discretionary bonus consideration. reputed company offers team members a competitive benefits package to address a wide reputed company of personal and family needs, including medical, dental, reputed company, disability, and life insurance coverage, 401(k) savings plans, reputed company family leave, 9 reputed company holidays per year, and 17-27 days of reputed company Time Off (PTO) per year, depending on specific level and length of service with reputed company. For information about our benefits package, please refer to our Careers page. Date of posting: 08/04/2025 Applications are assessed on a rolling reputed company. We anticipate that the application window will reputed company on 10/04/2025, but the application window may change depending on reputed company of applications received or reputed company immediately if a reputed company candidate is selected. #LI-JB1 #LI-Remote #director Apply tot his job Apply To this Job