[Hiring] Medical Director @Gainwell Technologies LLC

Role Description

We are seeking a talented individual for a Medical Director who provides clinical leadership and direction for projects and contracts in support of the Corporate Mission, Vision, and Values. The Medical Director also has responsibilities for:

• Quality of Care
• Peer Review
• Clinical Expertise
• Program Management and Development
• Physician Review Panels
• Quality of Care Review
• Outcome Measurement Programs
• HIPAA Privacy Expertise
• Utilization Review
• HIPAA Compliance
• Quality Assurance

Your role in our mission includes:

• Managing all aspects of Recovery Audit Program including audit review and appeal process, provider education and training, quality assurance, literature research, and hearing support.
• Providing clinical perspective and input to product development.
• Coordinating activities of employed physician reviewers, part time and contract physician reviewers, and assistant Medical Directors.
• Providing clinical expertise and support to corporate clients.
• Analyzing health care data for new market development, current operations, utilization management, fraud waste & abuse.
• Representing the organization in client presentations and responses to audits.
• Supporting the organizations' government and commercial clients in formal and informal hearings.
• Providing clinical expertise to project teams as requested.
• Representing the organization at contract/customer meetings to advocate for clinically relevant and economically feasible project studies.
• Presenting results of projects to relevant audiences to demonstrate the organization's position as a leader in Payment Integrity.
• Performing literature searches as indicated to determine appropriateness of review decisions, to determine experimental status, and to determine cosmetic versus medical necessity issues.
• Interacting with reviewers to clarify clinical issues, administrative issues, and scientific issues as they apply to specific reviews.
• Monitoring quality of reviewers and reviews for timeliness, completeness, and process compliance, while assuring appropriate levels of productivity and efficiency.
• Participating on quality improvement teams in support of Quality Assurance as assigned.

Qualifications

• A minimum of five (5) years of experience in utilization review.
• Must hold an active license (MD or DO), in good-standing. May require additional state specific medical licensure if needed.
• Graduate of an approved school of either Medicine or Osteopathy required. Completed accredited residency in United States (or equivalent) residency program.
• Five (5) years of experience in active practice.
• Proficiency in creating, querying, and analyzing reports.
• Experience and proficiency with InterQual and Milliman Care Guidelines.
• Medium skill set with computer and software usage.
• Strong writing skills with the ability to convey data in a clear and actionable manner.
• Demonstrated expertise and knowledge able to apply commercially available utilization guidelines such as InterQual or MCG.

Requirements

• Remote position within the U.S.
• 10% travel.
• The deadline to submit applications for this posting is December 4, 2026.
• The pay range for this position is $200,000.00 - $239,600.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors.

Benefits

• Generous, flexible vacation policy.
• 401(k) employer match.
• Comprehensive health benefits.
• Educational assistance.
• A variety of leadership and technical development academies to help build your skills and capabilities.