Medical Director

The 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.

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  Ensure NEMT services meet medical necessity and coverage requirements under NJ Medicaid guidelines

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  Review and approve medical policies related to transportation eligibility and utilization

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  Develop and maintain coverage and medical necessity policies in alignment with state and federal regulations

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  Collaborate with internal teams to implement best practices for claims processing and utilization review

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  Act as a primary clinical liaison with physician groups, beneficiary organizations, and regulatory agencies

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  Provide public relations support and represent the organization in meetings with healthcare providers and community partners

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  Ensure adherence to NJ Medicaid coverage and payment rules

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  Monitor and evaluate clinical processes for efficiency and compliance

• Licensed physician (MD/DO), registered nurse (RN), or nurse practitioner (NP) in the State of New Jersey with an active, unrestricted license

• Relevant Medicaid experience within the health insurance industry

• Strong understanding of NJ Medicaid programs, coverage, and payment rules

• 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)

• Health and Life Insurance Plans
• Dental and Vision Plans
• 401(k) with a company match
• Paid Time Off and Holiday Pay
• Maternity/Paternity Leave
• Casual Dress Environment
• Tuition Reimbursement
• MTM Perks Discount Program
• Leadership Mentoring Opportunities

This 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.

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