Cotiviti
Research Medical Director (Medicaid Medical Policy)
The Research Medical Director provides leadership to clinical teams, ensuring accurate interpretation and development of payment policies and medical coding guidelines. This role involves analyzing and enhancing the medical policy library, guiding internal and external processes related to Payment Policy Management policies and rules.
Key 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.
- • 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.
Required
- • A United States MD or DO degree is required.
- • 10+ years of Research experience.
- • Possess in depth knowledge of claims, claims adjudication, medical policy rules and edits.
- • 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.
- • 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.
- • 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.
Preferred
- • An MBA degree is preferred.
- • Experience working with a Medicaid payer preferred.
- • Knowledge of healthcare payers, policy payment and correct coding knowledge (preferred).
- • Strong organizational and project management experience preferred.
Benefits & Perks
- • Medical, dental, vision, disability, and life insurance coverage
- • 401(k) savings plans
- • Paid family leave
- • 9 paid holidays per year
- • 17-27 days of Paid Time Off (PTO) per year, depending on specific level and length of service
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.
Target start date for this position is 5/1/2026.
Responsibilities
Qualifications
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: 01/15/2026
Applications are assessed on a rolling basis. We anticipate that the application window will close on 3/15/2026, but the application window may change depending on the volume of applications received or close immediately if a qualified candidate is selected.
#director
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.
Target start date for this position is 5/1/2026.
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.
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.
- 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.
- 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.
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: 01/15/2026
Applications are assessed on a rolling basis. We anticipate that the application window will close on 3/15/2026, but the application window may change depending on the volume of applications received or close immediately if a qualified candidate is selected.
#director
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