Research Medical Director - Medicaid Medical

Title: Research Medical Director (Medicaid Medical Policy)

Location:

US-Remote

ID2026-17543

Category

Clinical

Position Type

Full-Time

Overview

The Research Medical Director is a key member of the Clinical and Policy research development area at Cotiviti. 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 internal and external processes as related to Payment Policy Management 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 Cotiviti policy.
• Reviews and identifies changes to medical policies in order to maintain an accurate and current 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 impact to medical policies.
• Ability to determine if an update to existing policy logic or content is warranted based on changes to industry. Perform QA of policy reviews, logic revisions, and research requests performed by others to ensure accuracy. In addition to QA, provides feedback to the originator as needed.
• Educates client-facing MDs and Client Policy Managers (CPMs) on new changes and policy updates by actively participating in monthly meetings for client facing MDs and CPMs.
• Ensures work is accurate, complete and finished in a timely manner including documentation of notable changes.
• Maintains current knowledgebase of industry and content, best practices, applications, procedures and policies.
• Complete all responsibilities as outlined in the annual performance review and/or goal setting.
• Complete all special projects and other duties as assigned.
• Must be able to perform duties with or without reasonable accommodation.

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 requirements of the job change.

Qualifications

• A United States MD or DO degree is required.  Additionally, an MBA degree is preferred.
• 10+ years of Research experience.
• Experience working with a Medicaid payer preferred.
• Knowledge of healthcare 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 success as a manager in a scalable organization that has significant scope, complexity and breadth.
• Strong personal leadership – in terms of the role of a leader, the impact on the company and creating.
• momentum for culture and accelerating the strategy.
• Relationship development skills to forge positive and lasting relationships with key business partners and clients.
• Ability to achieve 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 well independently and in a team 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, timely action and thorough execution.
• Understanding of and ability to lead and manage in a matrix environment where team work is essential.
• Ability to make good decisions that are strategically relevant to the 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 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 $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.

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Cotiviti is an equal employment opportunity employer. Cotiviti recruits, hires and promotes individuals based on their qualifications for a specific job. Selection of employees is made without regard to race, color, creed, sex, age, religion, pregnancy or pregnancy-related conditions, national origin, sexual orientation, gender identity, marital status, genetic carrier status, military service, veteran status, uniformed service member status, disability, or any other category of class protected by federal, state or local laws. All employment decisions and personnel actions, such as hiring, promotion, compensation, benefits, and termination, are and will continue to be administered in accordance with, and to further the principle of, equal employment opportunity.

Pay Transparency Nondiscrimination Provision
Cotiviti will not discharge or in any manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-I.35(c)