While "medical director" for a big insurance company sounds glamorous, I can assure you it is both boring and not very lucrative. Imagine doing chart reviews all day and talking to doctors on the phone who really don't have the time/interest in detailing the reasons why Ms. X is still an inpatient. Salaries are around 150k with 15-30% bonus. If you spend years there and make it to Chief medical director, this climbs to about 230-250k. You'll never be at the core of the business. Exit opportunities are non-existent, and in less you practice part-time on the weekends, your skills will quickly fade.