Medical Director at MTM

At MTM we are not just colleagues; we are collaborators on a shared mission;communities without barriers. We have exciting opportunities to join our growing team where your work has a direct impact on the communities we serve. Our company culture is one of innovation collaboration and growth. If you are passionate driven and ready to join a team where your work will directly transform and shape our industry then we want to talk to you!What will your job look likeThe Medical Director will provide clinical oversight and guidance for the administration of Non-Emergency Medical Transportation (NEMT) services under the New Jersey Medicaid program. The Medical Director will ensure compliance with state regulations develop medical necessity guidelines and serve as a liaison between healthcare providers beneficiary organizations and internal teams. The ideal candidate will have strong Medicaid experience expertise in utilization review and a collaborative approach to improving access to care.This position is contingent on award of contract.What youll do:Ensure NEMT services meet medical necessity and coverage requirements under NJ Medicaid guidelinesReview and approve medical policies related to transportation eligibility and utilizationDevelop and maintain coverage and medical necessity policies in alignment with state and federal regulationsCollaborate with internal teams to implement best practices for claims processing and utilization reviewAct as a primary clinical liaison with physician groups beneficiary organizations and regulatory agenciesProvide public relations support and represent the organization in meetings with healthcare providers and community partnersEnsure adherence to NJ Medicaid coverage and payment rulesMonitor and evaluate clinical processes for efficiency and complianceWhat youll need: Experience Education & Certifications:Licensed physician (MD/DO) registered nurse (RN) or nurse practitioner (NP) in the State of New Jersey with an active unrestricted licenseRelevant Medicaid experience within the health insurance industryStrong understanding of NJ Medicaid programs coverage and payment rulesMinimum of 3 years of experience with a utilization review firm or health care claims processing organizationExperience developing coverage or medical necessity policies and guidelinesPublic relations experience particularly with physician groups and beneficiary organizationsSkills:Excellent communication and interpersonal skillsStrong analytical and problem-solving abilitiesAbility to work collaboratively across clinical and operational teamsKnowledge of healthcare compliance and regulatory requirementsExperience handling sensitive and confidential information (HIPAA PHI)Whats in it for you: Health and Life Insurance PlansDental and Vision Plans401(k) with a company matchPaid Time Off and Holiday PayMaternity/Paternity LeaveCasual Dress EnvironmentTuition ReimbursementMTM Perks Discount ProgramLeadership Mentoring OpportunitiesSalary Min: $45/HRSalary Max: $80/HRThis information reflects the base salary pay range for this job based on current national market data. Ranges may vary based on the jobs location. We offer competitive pay that varies based on individual skills experience and other relevant factors. We encourage you to apply to positions that you are interested in and for which you believe you are qualified. To learn more you are welcome to discuss this with us as you move through the selection process.Equal Opportunity Employer: MTM is an equal opportunity employer. MTM considers qualified candidates with a criminal history in a manner consistent with the requirements of applicable local State and Federal law. If you are in need of accommodations please contact MTMs People & Culture. #MTMRequired Experience:Director Key Skills EMR Systems,Post Residency Experience,Occupational Health Experience,Clinical Research,Managed Care,Primary Care Experience,Medical Management,Utilization Management,Clinical Development,Clinical Trials,Leadership Experience,Medicare Employment Type : Full-Time Experience: years Vacancy: 1