Medical Director
$93,600–$166,400 year
On-site · Trenton, New Jersey, United States
Job Summary
Provide clinical oversight for Non-Emergency Medical Transportation (NEMT) services under the New Jersey Medicaid program, ensuring medical necessity and coverage compliance. Develop and approve medical policies related to transportation eligibility, formulate coverage and medical necessity guidelines aligned with state and federal regulations, and collaborate with internal teams to optimize claims processing and utilization review. Serve as a primary clinical liaison with physician groups, beneficiary organizations, and regulatory agencies; support public relations and represent the organization in healthcare meetings. Maintain adherence to NJ Medicaid rules, monitor clinical processes for efficiency and compliance, and participate in cross-functional efforts to improve access to care.
Required Qualifications
- Licensed physician (MD/DO), RN, or NP in New Jersey with an active, unrestricted license
- Relevant Medicaid experience within the health insurance industry
- Minimum of 3 years of experience with a utilization review firm or health care claims processing organization
- Experience developing coverage or medical necessity policies and guidelines
- Public relations experience, particularly with physician groups and beneficiary organizations
- Excellent communication and interpersonal skills
- Strong analytical and problem-solving abilities
- Ability to work collaboratively across clinical and operational teams
- Knowledge of healthcare compliance and regulatory requirements
- Experience handling sensitive and confidential information (HIPAA, PHI)
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