Medical Director

What will your job look like?

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.

This position is contingent on award of contract.

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

• Review and approve medical policies related to transportation eligibility and utilization

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

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

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

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

• Ensure adherence to NJ Medicaid coverage and payment rules

• 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

Salary Min: $45/HR

Salary Max: $80/HR

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.

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