SVP Medical Director

Sedgwick

Evaluating medical reports and providing clinical leadership at Sedgwick. Overseeing clinical quality control and supporting workers’ compensation and disability claims.

Posted 6/16/2026full-timeRemote • 🇺🇸 United StatesLead💰 $250,000 - $275,000 per yearWebsite

About the role

Key responsibilities & impact

To evaluate medical reports escalated due to deficient information utilizing evidence based criteria;
To provide leadership within the dedicated team of clinician and claim professionals.
Participate in client stewardship discussions, claim roundtables, and complex medical escalations.
Stay current on emerging medical trends, treatment standards, clinical literature, and evidence-based guidelines;
Support workers’ compensation, disability, FMLA, fitness-for-duty, return-to-work, liability, and safety-sensitive workforce issues.
Obtain and maintain Medical Director licensure in a few select states, as needed.
Apply applicable clinical guidelines and medical literature to support defensible recommendations, claim discussions, and treatment-plan clarification.
Engage treating providers when needed and support appeals, independent medical review considerations, peer review alignment, and clinical quality review.
Documenting recommendations within templates in Juris and SharePoint using the appropriate format referencing evidence-based criteria within the required time frame.
Developing and delivering training materials and presentations to meet training needs.
Interfacing and providing guidance and leadership to the Client dedicated leadership team as well as team leads.

Requirements

What you’ll need

Medical Doctor (M.D.) degree required.
Ten (10) of related experience required to include one (1) to three (3) years utilization review experience and three (3) years clinical quality control.
Knowledge of evidence-based guidelines
Knowledge of ADAA and FMLA
Knowledge of utilization review procedures
Knowledge of clinical quality systems and measurements
Knowledge of resources available regarding regulations and parameters of third party reimbursement, benefit determinations and payments
Knowledge of statutory requirements of state's jurisdiction/ERISA regulations
Knowledge about general claim practices.
Knowledge of pharmacy processes and pharmacy benefit management a plus.
Understanding of pain management a plus.
Excellent oral and written communication skills, including presentation skills
PC literate, including Microsoft Office products
Analytical and interpretive skills
Strong organizational skills
Excellent interpersonal skills
Proven management/leadership skills
Ability to create and complete comprehensive, accurate and constructive written reports
Ability to work in a team environment.

Benefits

Comp & perks

Three medical, and two dental & vision plans to choose from.
Tuition reimbursement
401K plan that matches 50% on every $ you put in up to the first 6% you save.
4 weeks PTO your first full year.
Reasonable accommodations when applicable and appropriate.

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

utilization reviewclinical quality controlevidence-based guidelinesclinical quality systemspharmacy benefit managementpain managementmedical report evaluationdefensible recommendationstreatment-plan clarificationregulations and parameters of third party reimbursement

Soft Skills

oral communicationwritten communicationpresentation skillsanalytical skillsinterpretive skillsorganizational skillsinterpersonal skillsmanagement skillsleadership skillsteamwork

Certifications

Medical Doctor (M.D.)Medical Director licensure