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Job Details

Requisition Number 18-1248
Title Medical Director
City Remote (work from home w/travel)
State US
Description

Overview

The Network Value Medical Director (MD) reports to the Cotiviti Medical director with a dotted line to Network Value Operations Solutions. The MD is a key member of the Cotiviti/Rowdmap Network Value team in clinically leading the development of our network value strategy and methodology.  Additionally, the MD takes point with the go-to-market (sales support) and client-facing team on clinically related issues related to network value, including tactics, benchmarking, peer grouping, client data considerations, various clinical nuances, and scoring methodology. The MD will provide comprehensive advice to and education of the Cotiviti/Rowdmap team, client physicians, and other client executives and specialists, who want to better understand how the scoring methodology works and how it could be used. The MD will also have a crucial voice in setting guidelines for methodological soundness and defensibility. Further, the MD will play a key leadership role in determining product, service and content development strategy over time, and helping define what Network Value support is needed from the research team and other sources, such as a pharmacist.

Product Development and Management Responsibilities

  • Provide clinical leadership in determining product strategy
  • Support network value team by providing clinical leadership in research & development
  • Develop, document and support metrics for network value scoring methodology(ies)
  • Prioritize, develop and refine ontologies
  • Contribute significantly to the development of tactics, benchmarking, and peer grouping
  • Participate in the ongoing development of the scoring methodology
  • Review and approve proposed client customization to data and scoring methodologies
  • Support/approve clinical collateral creation (ongoing)
  • Create standard provider education materials (webinars, standard guides, help content on the platform, etc.)
  • Identify research requirements and work with appropriate resources on the research team to support the development
  • Develop, maintain and validate “clinical soundness” of our source material, analytics, benchmarks, ontologies and tactics
  • Review the results of QA and testing of client-specific customization.
  • Develop and lead a clinical review board as appropriate to help review and validate methodology and to advise on future content, product and service development
  • Help determine other clinical support-related resource requirements, such as a consulting pharmacist

 

Provider Education and Client-Facing Responsibilities

  • Support new sales activity and existing client growth by identifying value creation opportunities for our clients
  • Participate in new client implementations as needed
  • Help as appropriate with new client set up on methodology, tactics, benchmarking and peer determination
  • Serve as methodology and clinical SME at methodology and provider communication Boot Camps with clients as needed
  • Conduct Institute for the Delivery of High-Value Care training sessions
  • Assist with the development of provider communication strategies and network tactics for health plan clients
  • Serve as methodology and clinical SME at specialty focus groups and/or provider group meetings with clients
  • Phone conversations and/or site visits with clients’ medical directors, other relevant staff
  • General clinical Q&A (live and with documentation) as needed

Additional Responsibilities

  • Works on educational materials and supporting documentation to explain the scoring methodology, peer typing, etc.
  • Coordinates with other Cotiviti MDs, pharmacy SMEs, and others as appropriate
  • Leads network value research and coordinates with the research and development resources available through Cotiviti
  • Drives and supports the vision and values of Cotiviti Healthcare and abides by all policies and procedures, including the development of goals and objectives (e.g., OKRs)
  • Improves and implements procedures as needed and/or assigned
  • Consistently provides optimum service to all internal and external customers
  • Consistently works to develop and maintain positive and professional relationships with all internal and external customers
Requirements

Key Attributes and Experience:

  • Degree in Medicine (MD or DO)
  • Excellent communications and credibility-building skills, especially as a physician SME
  • Prefer MPH with comprehensive understanding of population health policy and advanced statistical techniques
  • Experience in a health plan, Medicare or State Medicaid with experience in provider relations, network development, medical payment policy, etc.
  • In depth knowledge of network development, claims, claims adjudication, medical policy rules and edits, appeals and grievances
  • Willingness to attend relevant professional development and other training sessions
  • Public speaking experience and effectiveness
  • Minimum of 3 years of experience in a clinical setting
  • Minimum of 5 years’ experience in network development or related activity
  • Experience in private sector/ Health plan operations as a Medical Director, with focus on reimbursement, medical coding (CPT, ICD-10)
  • Consulting experience within a healthcare coding and reimbursement company is a definite plus
  • Strong analytical and problem solving skills
  • Excel and other Microsoft Office proficiency preferred
  • Strong organizational skills and adaptive capacity for rapidly changing priorities and workloads
  • Ability to respect and properly handle confidential information
  • Ability to work well independently and in a team environment
  • Ability to handle multiple tasks, prioritize and meet deadlines

Job Demands

  • Must be able to sit and use a computer keyboard for extended periods of time
  • Travel as required to client sites, conferences, Cotiviti offices and training sessions
  • Fast paced work with shifting priorities, intermittent travel the need to multi-task
  • Participate in onboarding and training process
  • Depending on home base, possible heavy initial travel associated with training
  • Must have ability to positively handle/manage stress, such as high work volume and frequent change
  • After hours and/or weekend work required where necessary for major deliverables/deadlines (not consistent)
  • We are an Equal Opportunity Employer.
  • Please view Equal Employment Opportunity Posters provided by OFCCP here.

  • 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.

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