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.
- 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
- 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
- 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
- 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.
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.
Cotiviti is an Equal Opportunity Employer. The Company provides equal employment opportunities to all applicants for employment without regard to gender, sexual orientation or preference, gender identity or expression, race, color, religion, national origin, ethnicity, ancestry, age, marital status, pregnancy, childbirth or related medical conditions, mental or physical disability, veteran status or any other characteristic protected by federal, state or local law, ordinance or regulation.
United States / Remote
Cotiviti is a leading solutions and analytics company that leverages unparalleled clinical and financial datasets to deliver deep insight into the performance of the healthcare system. These insights uncover new opportunities for healthcare organizations to collaborate to improve their financial performance, reduce inefficiency, and improve healthcare quality.
We focus on improving the financial and quality performance of our clients. In healthcare, this means taking in billions of clinical and financial data points, analyzing them, and then helping our clients discover ways they can improve efficiency and quality. In addition, we support retail and life/legal industries with data management and recovery audit services.
Cotiviti applies deep data science and market expertise to help healthcare organizations in three critical areas:
· Payment Accuracy: analyzing data flowing between payers and providers to ensure that claims are paid appropriately
· Risk Adjustment: ensuring that health plans accurately capture and report how sick their members are so that plans are appropriately reimbursed for the healthcare services their members receive
· Quality and Performance: evaluating healthcare cost, quality, and utilization at individual, provider, and population levels to identify the best opportunities for financial and clinical performance improvement