Medical Director - Implementation & Sales

Overview

The Medical Director focused on Implementation & Sales is a key member of the Go To Market team. The role is to serve as a coding and medical payment policy subject matter expert (SME). This position is responsible for supporting the sales process for our Payment Policy Management and Clinical Validation lines of business, reviewing and presenting results of the Opportunity Analysis supporting sales, and presenting policy/directing the client toward appropriate policy adoption during the implementation phase.  The Medical Director will then transition the client to a Client Medical Director after approximately 30 days post go-live. 

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
• Presenting data driven results and analyzing savings analysis with benchmark data to prospective target client's opportunity assessments
• Defines mission and strategy with the Sales Leader; delivers strategy to client’s medical policy team
• 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

Qualifications

• US licensed MD/DO with clinical and health plan experience
• 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
• 5+ years of Analytic and Opportunity Assessment skills required
• 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 required
• Exhibits behaviors consistent with Cotiviti Values

Mental Requirements:

• Communicating with others to exchange information
• Assessing the accuracy, neatness, and thoroughness of the work assigned

Physical Requirements and Working Conditions:

• The role can work at home anywhere in the continental United States (some travel is required)
• After hours and/or weekend work may be required where necessary for major deliverables /deadlines
• 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

Base compensation ranges from $190,000 to $260,000 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: Reposted - 2/27/25

Applications are assessed on a rolling basis. We anticipate that the application window will close on 4/27/2025, 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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