医疗总监
Medical Director
概述
客户医疗总监（CMD）是进入市场团队的关键成员。与客户参与负责人一起，CMD共同领导服务于医疗支付管理（PPM）客户的健康计划团队。CMD的角色是作为编码和医疗支付政策主题专家（SME）。CMD负责指导医疗政策委员会（与健康计划的医生、编码专家和支付完整性专家组成的联合委员会）。CMD将与客户建立关系，审查他们的数据，选择合适的医疗政策进行呈现，作为临床和编码专业知识的SME，并为客户的医疗总监提供后端支持。CMD将在医疗支付政策方面成为健康计划的可信赖顾问。
职责
- 通过识别为客户创造价值的机会，支持现有客户增长和新销售活动。
- 根据数据分析，向客户提供适当的支付政策以供采用。
- 与客户参与负责人定义使命和战略；将战略传达给客户的医疗政策团队。
- 与医疗政策团队合作评估和验证编辑内容。
- 作为与我们的健康计划客户之间的临床联络人。
- 为我们的医疗政策和解决方案团队的研究与开发工作提供建议。
- 深入了解索赔、索赔处理、医疗政策编辑和配置。
- 建立信任和可信度，履行承诺，提供增值分析。
- 协助发现其他Cotiviti产品销售的机会。
- 其他指定的职责。
本职位描述旨在描述工作的总体性质和水平，不应被理解为详尽的责任、职责和技能列表。本职位描述不构成雇佣协议，会根据Cotiviti的需求和职位要求的变化而进行调整。
资格要求
最低资格：
· 持有行医执照的MD/DO，具有临床和健康计划经验。
职位要求：
- 在健康计划运营中担任医疗总监的经验，专注于医疗政策、医疗编码、支付完整性和/或欺诈/浪费/滥用。
- 临床医学经验。
- 适应快速变化的优先级和工作量，具备多任务处理、优先排序和按时完成任务的能力。
- 客户关系技能 - 能够建立牢固的专业关系
查看英文原文
Overview
The Client Medical Director (CMD) is a key member of the Go To Market team. Along with the Client Engagement Leader, the CMD co-captains the team serving the Prospective Payment Management (PPM) client team at the health plan. The CMDs role is to serve as a coding and medical payment policy subject matter expert (SME). The CMD is responsible for directing the Medical Policy Committee (joint committee with health plan MD, coding experts, and payment integrity). The CMD will develop a relationship with the client, review their data, select medical policy to present, serve as SME for clinical and coding expertise, and back end support for the client’s Medical Director. The CMD will evolve as the trusted advisor for the Health Plan in terms of medical payment policy.
Responsibilities
- Supporting existing client growth and new sales activity by identifying value-creation opportunities for our clients.
- Presents appropriate payment policy to clients for adoption based on review of data analytics.
- Defines mission and strategy with Client Engagement Leader; delivers strategy to client’s medical policy team.
- Works alongside Medical Policy team to evaluate and validate editing.
- Acts as a clinical liaison with our health plan clients.
- Lend guidance to the research & development efforts of our Medical Policy and Solutions teams.
- Have in-depth knowledge of claims, claims adjudication, medical policy edits and configurations.
- Inspire trust and credibility, deliver on commitments, provide value-add analytics.
- Assist in discovering opportunities for other Cotiviti product sales.
- Other duties as assigned.
This job description 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 description does not constitute an employment agreement and is subject to change as the needs of Cotiviti and the requirements of the job change.
Qualifications
Minimum Qualifications:
· Licensed MD/DO with clinical and health plan experience.
Position Requirements:
- Experience in Health plan operations as a Medical Director, with focus on medical policy, medical coding, payment integrity and/or fraud/waste/abuse.
- Experience in clinical medicine.
- Adaptive capacity for rapidly changing priorities and workloads, multitasking, prioritizing and meeting deadlines.
- Client Relationship Skills - Ability to develop strong professional relationships with multiple roles and levels.
- Comfortable with presenting to small and large groups of people.
- Strong organizational, analytical and problem-solving skills.
- Results driven with focus on producing high-quality, error free service and deliverables.
- Ability to work well independently and in a team environment.
- Excellent verbal and written communication skills.
- Proficient with Microsoft Office Suite (Word, Excel, Power Point); advanced Excel proficiency preferred.
- Exhibits behaviors consistent with Cotiviti values.
Job Demands:
- The role can work at home anywhere in the continental United States (some travel is required ~10%).
- Able to use computer keyboard for extended periods of time.
- After hours and/or weekend work may be required where necessary for major deliverables /deadlines.
Mental Requirements:
- Communicating with others to exchange information.
- Assessing the accuracy, neatness, and thoroughness of the work assigned.
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 able to provide a dedicated, secure work area.
- Must be able to provide high-speed internet access/connectivity and office setup and maintenance.
- No adverse environmental conditions expected.
Base 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.
Cotiviti offers team members a competitive benefits package to address a wide range of personal and family needs, including medical, dental, vision, disability, and life insurance coverage, 401(k) savings plans, paid family leave, 9 paid holidays per year, and 17-27 days of Paid Time Off (PTO) per year, depending on specific level and length of service with Cotiviti. For information about our benefits package, please refer to our Careers page.
Date of posting: 8/14/2026
Applications are assessed on a rolling basis. We anticipate that the application window will close on 10/14/2026, but the application window may change depending on the volume of applications received or close immediately if a qualified candidate is selected.
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Originally posted on Himalayas