Medical Director

Medical DirectorThe 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 you'll 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 you'll need: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)What's 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 job's 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 MTM's People & Culture.