About this opportunity
Tacony Corporation lists this Medical Director opportunity in trenton, New Jersey. Review the employer’s description below for duties, qualifications and application requirements.
Job description
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.
What you’ll do:
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
What you’ll need:
Experience, Education & Certifications:
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
Skills:
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)
What’s in it for you:
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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Worksite address
trenton, NJ, 08628, US
Who can apply
Review the original listing for work authorization, qualifications and employer requirements.