Executive Medical Director – Payment Integrity

Health Care Service Corporation

. Responsible for assigned aspects of medical policies and programs .

Posted 10/6/2026full-timeUnited StatesLead💰 $214,800 - $398,900 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise as a Physician (M.D. or D.O) with extensive experience in managed care, medical policy development, and strategic decision-making. Proven ability to lead teams, communicate effectively, and implement process improvements aligned with business strategies.

Highest-signal resume keywords

Physician License (M.D. or D.O)Board CertificationManaged Care ExperienceStrategic Decision-MakingLeadership Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Medical ReviewCost-Benefit AnalysisProcess ImprovementReimbursement MethodologyBenefit ManagementClinical ExperienceBusiness Strategy DevelopmentPayment Integrity ExperienceLegal/Compliance ExperienceInnovative Thinking

Soft Skills

Strong Verbal CommunicationStrong Written CommunicationConsensus BuildingResults OrientationNegotiation Skills

Tools & Technologies

Microsoft OfficeLotus Notes

Certifications & Qualifications

Current Physician LicenseBoard Certification by Specialty Board

Industry Keywords

Medical PoliciesProvider Community InteractionOperational NeedsCorporate StrategyPatient Care

About the role

Key responsibilities & impact

Responsible for assigned aspects of medical policies and programs
Perform medical reviews
Interact with provider communities for assigned areas
Oversee the annual budget and allocate resources for various projects and operational needs
Translate needs and initiatives into compelling business cases
Conduct cost-benefit analyses to justify investments and ensure ROI
Lead groups toward consensus and resolution aligned with corporate strategy
Develop process improvements aligned with business strategies
Present and negotiate
Make strategic decisions and execute actions on strategies

Requirements

What you’ll need

Physician (M.D. or D.O) with a current and unrestricted physician license in a state or territory of the United States
Maintain Board Certification by a specialty board approved by the American Board of Medical Specialties, National Board of Physicians and Surgeons, or the Advisory Board of Osteopathic Specialists
5 years of post-graduate patient care/clinical experience
5 years of managed care experience coupled with proven experience in the application of medical problems to managed care practices
Knowledge of current medical and surgical techniques, reimbursement methodology, and benefit management
Leadership skills to lead groups to consensus and resolution building aligned to corporate strategy
Demonstrated ability to independently make tough strategic decisions and move forward with actions on the strategies
Strong verbal and written communication skills
Experience achieving results through people
Experience being proactive and highly results oriented; able to meet deadlines under pressure
Experience thinking innovatively and developing process improvements to align with business strategies
Experience being the subject matter expert/leader in a specified field
Experience presenting and negotiating
Strategic thinking skills
Proficiency in computer use, including Microsoft Office products and Lotus Notes
Experience developing business strategies and leading broad medical policy initiatives (preferred)
Legal/compliance experience (preferred)
Payment integrity/reimbursement experience (preferred)
Employment may be contingent upon successful completion of drug screening in accordance with applicable law

Benefits

Comp & perks

Curated development plans that foster growth and promote rewarding, fulfilling careers
Health and wellness benefits
401(k) savings plan
Pension plan
Paid time off
Paid parental leave
Disability insurance
Supplemental life insurance
Employee assistance program
Paid holidays
Tuition reimbursement
Other incentives
Annual incentive bonus plan