Research Medical Director – Medicaid Medical Policy

Cotiviti

Research Medical Director shaping Medicaid payment policies and coding rules at Cotiviti, a healthcare analytics company. Leading clinical research, policy development, analytics, quality assurance, and client education.

Posted 8/21/2026full-timeRemote • 🇺🇸 United StatesLead💰 $225,000 - $275,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in medical policy development, payment policy management, and claims adjudication, with a strong focus on leadership and relationship development within clinical teams. Proven ability to analyze complex data and implement strategic decisions in a fast-paced healthcare environment.

Highest-signal resume keywords

MD Or DO Degree10+ Years Of Research ExperienceKnowledge Of Healthcare PayersClaims Adjudication ExpertiseStrong Organizational Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Policy DevelopmentData AnalysisMedical CodingQuality AssuranceProject ManagementPerformance ReviewResearch InquiriesPolicy Logic AssessmentPayment Policy ManagementClaims Management

Soft Skills

LeadershipRelationship DevelopmentCommunication SkillsTeam CollaborationTime Management

Certifications & Qualifications

MD Or DO DegreeMBA Degree Preferred

Industry Keywords

HealthcareMedicaid PayerMedical Policy LibraryClaims AdjudicationPayment Policy

About the role

Key responsibilities & impact

Provide leadership guidance to clinical teams
Ensure Rules and policies are accurately interpreted and developed
Analyze, interpret, and develop policies to enhance the medical policy library
Guide internal and external processes related to Payment Policy Management policies and rules
Interpret and assess payment policy and medical coding information against the policy library
Research and analyze medical policy items
Perform multifaceted data and report analytics
Translate industry references into Cotiviti policy
Review and identify changes to maintain an accurate and current medical policy library
Identify new opportunities from clinical references and analytical sources
Analyze research inquiries and apply clinical judgment to determine potential impact on medical policies
Determine whether updates to policy logic or content are warranted
Perform quality assurance of policy reviews, logic revisions, and research requests
Provide feedback to originators as needed
Educate client-facing MDs and Client Policy Managers on changes and updates through monthly meetings
Ensure work is accurate, complete, timely, and properly documented
Maintain current knowledge of industry content, best practices, applications, procedures, and policies
Complete performance-review responsibilities, special projects, and assigned duties

Requirements

What you’ll need

A United States MD or DO degree is required
MBA degree preferred
10+ years of research experience
Experience working with a Medicaid payer preferred
Knowledge of healthcare payers, payment policy, and correct coding preferred
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 with significant scope, complexity, and breadth
Strong personal leadership
Relationship development skills with key business partners and clients
Ability to achieve sustainable results through others, including developing and assigning MDs and administrative staff as leaders, mentors, and trainers
Ability to work independently and in a team environment
Ability to handle multiple tasks, prioritize, and meet deadlines
Highly organized
Excellent written and verbal communication skills and strong listening skills
Ability to work in a fast-paced, entrepreneurial environment with deep analysis, timely action, and thorough execution
Understanding of and ability to lead and manage in a matrix environment
Ability to make strategically relevant decisions
Ability to provide a dedicated, secure work area
High-speed internet access/connectivity and office setup and maintenance
Must be able to perform duties with or without reasonable accommodation

Benefits

Comp & perks

Medical, dental, vision, disability, and life insurance coverage
401(k) savings plan
Paid family leave
9 paid holidays per year
17–27 days of Paid Time Off (PTO) per year, depending on level and length of service
Remote work
Discretionary bonus consideration