Medical Director

• Lead, supervise, and support provider teams, ensuring clinical quality and regulatory compliance.
• Manage hiring, training, coaching, and performance evaluation for direct reports.
• Strategically deploy clinical resources using data-driven KPIs to achieve market and organizational goals.
• Develop and nurture partnerships with local clinical communities, health plans, and other key stakeholders.
• Champion our value-based, patient-centered care model for the frailest and most vulnerable populations.
• Deliver clinical oversight for patient care, including annual wellness visits, urgent care, care transitions, and continuity care.
• Participate in care team huddles, providing expert clinical guidance to drive better outcomes and overall performance improvements.
• Ensure compliance with all medical and operational policies, protocols, and guidelines.
• Support direct patient care and on-call activities as needed.

Market Medical Director

• Responsible for assisting the Medical Director in the oversight of Utilization Management (UM) programs
• Support the development and maintenance of these programs, focusing on clinical accuracy and appropriateness
• Assist the Medical Director in developing strategic corporate direction for UM programs
• Support the SVP, Healthcare Services in preparing annual metrics of results for UM programs
• Contribute to measurable outcomes for prior authorization, step therapy, and quantity limit programs
• Collaborate with internal teams to support corporate HEDIS initiatives with appropriate clinical program development
• Work closely with clinical program development teams, clinical service operations, and clinical quality committees
• Provide clinical guidance and oversight to these areas
• Serve on IH committees as directed by the Medical Director

Associate Medical Director – UM PT

• Supports clinicians to ensure timely and consistent responses to members and providers
• Provides guidance for clinical operational aspects of a program
• Serves as a resource and consultant to other areas of the company
• May be required to represent the company to external entities and/or serve on internal and/or external committees
• May chair company committees
• Interprets medical policies and clinical guidelines
• May develop and propose new medical policies based on changes in healthcare
• Leads, develops, directs, and implements clinical and non-clinical activities that impact health care quality cost and outcomes
• Identifies and develops opportunities for innovation to increase effectiveness and quality

Medical Director – Medicare Fee for Service

• Oversees the administration of behavioral health services to ensure members receive appropriate, high-quality, and cost-effective care
• Provides clinical consultation and strategic guidance to strengthen clinical operations
• Supports the design and implementation of initiatives that improve quality, outcomes, and affordability
• Identifies and develops opportunities for innovation to increase effectiveness and quality
• Conducts peer-to-peer clinical reviews with attending physicians or other providers
• Serves as a resource and consultant to other areas of the company
• Attends Behavioral Health interdisciplinary team (IDT) meetings and other team-related meetings regularly

Behavioral Health Medical Director – Psychiatrist

• Support BeOne Pre-Clinical and Clinical pipeline development by coordinating external collaborations, research endeavors with health care providers and external academicians while ensuring internal partnership across the organization.
• Report to the Senior Regional Director, Hematology, within Medical Affairs.
• Develop regional strategies to support enduring and compliant relationships with Opinion Leaders, Research Collaborators & Key Organizations in support of BeOne pipeline development (Solid Tumor or Hematology).
• Provide pre-launch and post-launch Medical Affairs support for hematology pipeline development.
• Work closely with internal colleagues in medical affairs, clinical development, program leadership, clinical operations, legal, compliance, new product planning, safety/pharmacovigilance, molecular diagnostics, marketing, sales and translational research.
• Play a key role in the establishment of BeOne as a valued collaborator and best-in-class biopharmaceutical company.
• Work with Cross-functional teams to develop robust territory plans that impact and inform HCPs leading to improved patient outcomes.
• Establish and maintain scientifically credible peer-to-peer scientific relationships with national & regional opinion leaders in addition to other healthcare providers.
• Facilitate & monitor strategic partnerships with scientific/clinical experts and serve as an enterprise-level point of contact with organizations including but not limited to - Guideline development, Cooperative groups, Other (National Cancer institutions).
• Serve as an internal resource of clinical and scientific information from medical interactions.
• Provide impactful feedback/information to internal stakeholders on emerging clinical and scientific trends.
• Nominate sites to Clinical Operations to participate in clinical research.
• Contribute to or perform therapeutic area/indication research and competitor analysis.
• Assist in the development and execution of clinically relevant regional medical meetings (e.g., advisory boards, consultant, and investigator meetings), as requested.
• Identification and verification of investigators and sites for company-sponsored clinical trials.
• Serve as a liaison for the submission and review of Investigator Sponsored Research proposals.
• Support major and regional congresses engaging thought leaders.
• Build strong relationships with internal experts.
• Identify continuous process improvement opportunities.
• Develop, track, execute and report on goals and objectives.
• Support Medical Affairs budget planning and management.
• Be accountable for compliant business practices.

Senior Field Medical Director – Florida/PR

• Understand organizational & market priorities, trends, and goals, to develop a clinical strategy to advance clinical talent and performance
• Interview, hire, and supervise clinical teams to staff and develop a high-quality clinical team with strong engagement, patient-first culture, and talent retention
• Closely engage and communicate with clinicians and care teams, conducting weekly onsite center visits, holding regular individual 1:1s and clinician pod meetings, and actively participating in monthly leadership meetings
• Deeply understand, support, and improve primary care clinician performance through understanding of individual & care team context, effective use of data, and effective coaching of clinicians and care teams
• Engage in regular market performance (clinical, financial, operational) meetings on key topics such as Medical Risk Adjustment (MRA), budgeting, staffing, operational excellence, and clinical initiatives
• Champion our senior-focused primary care strategic vision and initiatives and foster stakeholder relationships, including health plan partners, healthcare providers (e.g. specialists, hospitals) and social services, to improve our community of care locally
• Represent CenterWell/Conviva brands in local communities and related media activities while collaborating with the recruitment team to build and network a pipeline of high-quality primary care clinicians (physicians, APPs, MAs, and other clinical professionals)
• Utilize clinical performance dashboards and data tools to support stack ranking, performance analysis, and targeted strategy development
• Foster a culture of continuous learning and professional growth among clinical teams
• Deliver leading clinical performance in patient experience, quality of care, clinical outcomes, and avoidable utilization
• Monitor and manage daily patient care and initiatives to improve team-based key performance indicators (KPIs), such as patient experience via Net Promoter Score (NPS) and Medicare clinical quality via HEDIS, meeting local and organizational goals
• Personally deliver high-quality primary care and demonstrate a high degree of patient care ownership and clinical excellence in age-friendly senior primary care including health promotion & prevention, disease management, effective specialist & hospital co-management, and complex care management

Associate Medical Director

• Provide clinical leadership for utilization management programs
• Set UM strategy aligned with organizational goals
• Serve as senior clinical advisor to executive leadership on utilization trends
• Oversee the medical policy team
• Lead the Medical Policy and Utilization Management Governance Committees
• Oversee complex and high-risk utilization review cases
• Conduct clinical reviews and peer-to-peer reviews
• Ensure consistent, evidence-based application of clinical guidelines
• Provide clinical expertise to teams conducting coding and payment integrity
• Act as senior clinical UM liaison to network providers
• Build and maintain strong physician relationships
• Lead development and implementation of UM interventions
• Review utilization data for improvement opportunities
• Ensure UM programs meet regulatory requirements
• Conduct and support training of medical directors and UM staff

Senior Medical Director

• Leverage your background in Pain Medicine disciplines to deliver evidence-based medical reviews that support high-quality patient care.
• Collaborate with healthcare providers and stay current on healthcare regulations and industry developments as you review a wide range of cases.
• Start training remotely in a structured environment with support from trainers, mentors, and leadership to set you up for success.
• Complete time-sensitive, specialized evidence-based medical case reviews for medical necessity on EviCore’s case management software.
• Conduct physician consultation (peer-to-peer) calls with referring providers to discuss evidence–based medical necessity and appropriateness of the requested service or treatment.
• Leverage your clinical expertise to recommend alternative services or treatments as necessary.
• Work collaboratively with over 500 EviCore physician colleagues to help ensure patients receive proper care via evidence-based decision making.

Medical Director – Pain Medicine

• Design, implement, and improve education, quality, and accreditation programs
• Develop and manage training curriculum for clinical staff
• Design and deliver palliative care-specific education programs
• Integrate value-based care principles into training frameworks
• Oversee simulation-based training and competency assessments
• Lead the organization's QA/QI program and establish quality metrics
• Analyze clinical and operational data for improvement
• Collaborate with the Compliance Department for regulatory education

Clinical Director – Training & Quality

• Develop and manage the Clinical Policy, Regulatory, and Compliance functions within the Office of Clinical Affairs.
• Ensure clinical operations meet healthcare laws and standards.
• Develop and maintain regulatory policies.
• Manage compliance risks and guide policy-related submissions.
• Advise senior leadership and work closely with teams across the organization.

Medical Director, Clinical Regulatory Affairs

• You’ll start training remotely in a structured environment with support from trainers, mentors, and leadership to set you up for success.
• Complete time-sensitive, specialized evidence-based medical case reviews for medical necessity on EviCore’s case management software.
• Conduct physician consultation (peer-to-peer) calls with referring providers to discuss evidence–based medical necessity and appropriateness of the requested service or treatment.
• Leverage your clinical expertise to recommend alternative services or treatments as necessary.
• Work collaboratively with over 500 EviCore physician colleagues to help ensure patients receive proper care via evidence-based decision making.

Medical Director – Pathology

Medical Director – Medical Genetics, Genomics

• Medical Director responsible for the administration of physical and/or behavioral health medical services.
• Ensure the appropriate and most cost-effective medical care is received.
• May be responsible for developing and implementing programs to improve quality, cost, and outcomes.
• Provides clinical consultation and serves as clinical/strategic advisor.
• Identifies cost of care opportunities.
• Serves as a resource to staff including Medical Director Associates.
• Conducts peer-to-peer clinical reviews and may represent the company to external entities and/or serve on committees.

• Provide clinical oversight and medical direction for vision related programs and services.
• Ensure clinical policies, guidelines, and practices align with evidence based ophthalmology standards and applicable regulatory requirements.
• Serve as the senior clinical authority for ophthalmology related questions, escalations, and complex case reviews.
• Ensure compliance with GAAP, healthcare-specific regulations, and internal policies.
• Perform and oversee utilization management reviews related to ophthalmology and vision services.
• Conduct medical necessity determinations for prior authorization, concurrent, and retrospective reviews.
• Review and adjudicate clinical appeals and denials, including peer to peer discussions with ordering and rendering providers.
• Collaborate with operational and compliance teams to ensure utilization management activities meet contractual, regulatory, and accreditation standards.
• Act as a client‑facing clinical leader and ophthalmology specialist for Health Network One’s vision service lines.
• Participate in client meetings, presentations, and consultations to explain clinical programs, utilization management decisions, and outcomes.
• Support client relationships, retention, and growth by providing credible, thoughtful clinical guidance.
• Represent Health Network One with external stakeholders, including health plans, provider partners, and regulatory entities, as appropriate.
• Partner with the CEO and executive leadership team to support strategic planning, clinical program design, and growth initiatives for vision services.
• Provide clinical insight to inform organizational decision making, risk management, and performance improvement efforts.
• Contribute to the development and refinement of clinical workflows, quality initiatives, and performance metrics aligned with organizational goals.
• Ensure compliance with federal and state regulations, accreditation standards, and client contractual requirements.
• Support quality management activities related to ophthalmology and vision services, including audits, reporting, and corrective action planning.
• Promote a culture of clinical excellence, accountability, and patient centered decision making.

Medical Director, Vision

• Determine the medical appropriateness of inpatient, outpatient, and pharmacy services by reviewing clinical information and applying evidence-based guidelines.
• Influence departmental strategy, leading and overseeing a team of physicians ensuring efficient management and adherence to quality standards.
• Report into the Senior Medical Director.
• Provide timely medical reviews that meet Oscar's stringent quality parameters.
• Provide clinical determinations based on evidence-based criteria and Oscar internal guidelines and policies, while utilizing clinical acumen.
• Clearly and accurately document all communication and decision-making in Oscar workflow tools.
• Use correct templates for documenting decisions during case review.
• Conduct timely peer-to-peer discussions with treating providers to clarify clinical information and to explain review outcome decisions.
• Manage direct reports and oversee their performance.
• Provide oversight to ensure the team meets turn-around times for clinical reviews.
• Collaborate with other departments on Utilization Management Operations.
• Lead key projects and drive initiatives to successful completion.

Associate Medical Director, Utilization Management

• Provide clinical oversight and medical direction for dermatology‑related programs and services.
• Ensure clinical policies, guidelines, and practices align with evidence‑based dermatology standards of care and applicable regulatory requirements.
• Serve as the senior clinical authority for dermatology‑related questions, escalations, and complex case reviews.
• Perform and oversee utilization management reviews related to dermatology services.
• Conduct medical necessity determinations for prior authorization, concurrent review, and retrospective review.
• Review and adjudicate clinical appeals and denials, including peer‑to‑peer discussions with ordering and rendering providers.
• Collaborate with operational and compliance teams to ensure utilization management activities meet contractual, regulatory, and accreditation standards.
• Act as a client‑facing clinical leader and dermatology specialist for Health Network One’s dermatology service lines.
• Participate in client meetings, presentations, and consultations to explain dermatology clinical programs, utilization management decisions, and outcomes.
• Support client relationships, retention, and growth by providing credible, data‑driven clinical guidance.
• Represent Health Network One with external stakeholders, including health plans, provider partners, and regulatory entities, as appropriate.
• Partner with the Chief Medical Officer and executive leadership team to support strategic planning, clinical program design, and growth initiatives for dermatology services.
• Provide clinical insight to inform organizational decision‑making, risk management, and performance improvement efforts.
• Contribute to the development and refinement of clinical workflows, quality initiatives, and performance metrics aligned with organizational goals.
• Ensure compliance with federal and state regulations, accreditation standards, and client contractual requirements.
• Support quality management activities related to dermatology services, including audits, reporting, and corrective action planning.
• Promote a culture of clinical excellence, accountability, and patient‑centered decision‑making.

Medical Director, Dermatology

• Provide therapeutic area/product expertise in hematology across a broad range of medical customer segments
• Plan and execute medical strategy and engagement for assigned customers within Florida
• Maintain required level of knowledge of relevant TA/disease states and Pfizer medicines
• Serve as a conduit and resource for Medical Information and customer insights
• Collaborate with Global Medical Affairs colleagues to identify potential sites for clinical trials

Oncology Field Medical Director – MD

• Plan and execute medical strategy and engagement for appropriate assigned customers within a territory (Florida), compliantly coordinating with other Pfizer colleagues as needed to achieve medical objectives
• Maintain required level of knowledge of relevant TA (malignant hematology associated disease states) and Pfizer medicines, providing therapeutic area/product information to both internal and external stakeholders as needed
• Serve as a conduit and resource for medical information and customer insights, providing requested information to HCPs as allowed by Pfizer guidance and sharing customer viewpoints with Pfizer as appropriate
• Understand the priorities of Pfizer Medical Affairs to contribute to medical content strategy development and execute aligned Field Medical tactics
• Maintain effective and appropriate communication and collaboration among headquarters medical colleagues and other Pfizer Field Medical colleagues
• Demonstrate expertise in communication across multiple channels, including, but not limited to, live and virtual presentations in small or large settings, written communication, and telephone or virtual conversations
• Optimize patient centricity of medical communications and deliverables, incorporating health literacy and cultural awareness principles to ensure that patients remain the ultimate focus
• Deliver approved medical content about Pfizer medicines and relevant topics in the designated therapeutic area, malignant hematology
• Identify and seek medical engagement from priority customer segments in malignant hematology
• Provide truthful, accurate, and scientifically supported information in response to direct unsolicited medical requests from HCPs in a manner that complies with all applicable Pfizer guidelines, policies, and procedures
• Field relevant inbound queries from HCPs via established triage process
• In collaboration with Global Medical Affairs colleagues, partner with Oncology Research & Development and Global Product Development (GPD) in the identification of potential sites for Pfizer-sponsored clinical trials, including identification of sites serving under-represented patient populations in trials
• Appropriately provide medical support throughout the Investigator Sponsored Research (ISR) process
• Cultivate research and malignant hematology expertise, including familiarity with latest congress data and disease state literature
• Provides asset leadership

Hematology Field Medical Director, non-MD

• Provide clinical leadership and expertise in the development of quality improvement strategies and special projects to support the enterprise quality organization
• Advise teams about strategies for improvement or adjustment of their programs or products
• Clinical leadership of the environmental resiliency portfolio: coordinate research, manage relationships with key stakeholders, and present on findings to internal and external audiences
• Collaborate cross functionally with teams to review clinical products and programs for clinical accuracy and evidence
• Demonstrate agility and resilience while working in a dynamic, ever-changing work environment
• Be passionate about data and project work in a complex, large organization

Medical Director – Clinical Quality Initiatives

• Serve as the clinical authority for clinical data definitions and decision logic frameworks
• Build team capability in clinical data science and outcomes measurement
• Serve as the clinical informatics subject matter expert for product teams
• Review and approve clinical-facing content and logic for accuracy
• Partner with Data/Analytics and Data Science teams to define analytical approaches

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