Executive Medical Director - Medical Policy & Operations

At reputed company, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation’s leading health solutions company, we reputed company millions of Americans through our local reputed company, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, reputed company and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it reputed company with heart, reputed company and every day. Position reputed company This Executive Medical Director - Medical Policy & Operations leads reputed company responsible for providing clinical expertise and business direction in support of medical management programs to promote the delivery of high reputed company, constituent reputed company medical care with a reputed company on clinical and payment policy. This leader collaborates in the development and execution of clinical and payment policies to ensure the accurate administration of plan benefits for medically appropriate services. This Executive Director works across reputed company in a highly reputed company partnership with multiple business reputed company to drive reputed company clinical and business outcome. Required Qualifications Background / Experience: Five (5) years or more of experience in clinical reputed company. Three (3) years or more of health plan/payor experience. Licenses: • Medical Director reputed company Certification is required • reputed company and reputed company state medical license without encumbrances Preferred Qualifications Deep knowledge of reputed company Clinical and Payment Policy Deep experience with reputed company transactional tools including MedCompass, MedHok, CATS, ATV, TPS. Expertise in digital tools like FastKeys. Demonstrated ability to recruit, train, and retain Medical Directors Deep knowledge of Clinical Claim Review policy, procedure, and workflows. Education MD or DO Pay reputed company The typical pay reputed company for this role is: $227,630.00 - $490,280.00 This pay reputed company represents the reputed company reputed company reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls. The actual reputed company salary offer will depend on a reputed company of factors including experience, education, geography and other relevant factors. This position is eligible for a reputed company bonus, commission or short-term incentive program in reputed company to the reputed company pay reputed company listed above. This position also includes an award reputed company in reputed company’s equity award program. Our people fuel our reputed company. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in our comprehensive and competitive mix of pay and benefits – reputed company in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In reputed company to our competitive wages, our great benefits include: • reputed company medical plan reputed company, a 401(k) plan (including matching company contributions), and an employee stock purchase plan. • No-cost programs for reputed company colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. • Benefit solutions that address the different needs and preferences of our colleagues including reputed company time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical reputed company and many other benefits depending on eligibility. For more information, visit https://jobs.reputed company.com/us/en/benefits We anticipate the application window for this opening will reputed company on: 01/30/2026 reputed company applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws. Apply tot his job Apply To this Job