Medical Director

• Serve as a senior clinical leader and addiction medicine subject matter expert across the organization.
• Partner with Clinical Services leadership to strengthen clinical quality, consistency, and patient safety across Boulder’s care delivery model.
• Lead routine review and refinement of clinical protocols, formulary standards, and evidence-based practice guidelines.
• Support quality assurance activities, chart review processes, and clinical audits to identify opportunities for improvement.
• Provide consultation and guidance on complex clinical cases and emerging clinical issues.
• Ensure Boulder’s clinical standards remain aligned with current evidence, regulatory requirements, and payer expectations.
• Partner with Clinical Services leadership to strengthen clinical leadership capabilities across the organization.
• Provide mentorship, coaching, and support to clinical leaders and clinicians navigating complex clinical and operational challenges.
• Help establish and reinforce standards of clinical excellence, professional growth, and evidence-based practice.
• Contribute physician leadership and oversight to clinician education, onboarding standards, and ongoing clinical development programs.
• Support the development of systems that promote accountability, consistency, and continuous improvement across the clinical organization.
• Translate quality findings, operational priorities, and emerging evidence into scalable clinical workflows and care delivery standards.
• Identify gaps in clinical processes, policies, and infrastructure and partner across teams to implement solutions.
• Support implementation of new clinical initiatives and ensure clinical best practices are operationally viable and consistently applied.
• Drive adoption of new clinical workflows, protocols, and care models across a distributed clinical workforce.
• Partner with Medical Affairs and Clinical Services leadership to evaluate and support expansion into new service lines and care models.
• Assess clinical readiness, staffing considerations, protocol requirements, and quality implications for new programs.
• Ensure new services are designed with appropriate clinical governance, quality standards, and outcome measurement strategies.
• Contribute clinical expertise to Boulder’s long-term vision of comprehensive substance use disorder care.
• Serve as a clinical liaison to Product, Operations, Analytics, and other cross-functional teams.
• Translate clinical priorities into product requirements, workflows, and operational processes.
• Provide clinical input on care delivery technology, clinical decision support tools, AI-enabled workflows, and platform enhancements.
• Ensure operational and product changes are evaluated through the lens of patient safety, clinician experience, clinical effectiveness, and quality.

Medical Director – Addiction Medicine, Telehealth

• Oversee the performance and growth of Customer Service, Prescription Processing, Client-specific teams, managing both internal staff and external vendors
• Lead operational excellence across central fill pharmacy networks and courier delivery operations
• Lead your team with Key Performance Indicators (KPIs) to drive business success and increase efficiency while lowering the cost-to-fill on an annual basis
• Manage quality, turnaround time (TAT), and customer satisfaction metrics to ensure FuzeRx remains the preferred infrastructure partner for telehealth and pharma partners
• Establish requirements for capabilities and reporting, collaborating cross-functionally to deliver data-driven insights
• Analyze data to forecast staffing needs based on program performance, optimizing resource allocation across multiple roles
• Lead a large team of managers, supervisors and team members, establishing an environment of positive employee engagement and experience

Director, Rx Clinical Operations

• Define and execute Medicaid risk adjustment strategy across markets and plans
• Lead and deliver high-impact strategic initiatives that improve revenue accuracy, compliance, and overall performance
• Align risk adjustment programs with state Medicaid models (e.g., CDPS, CRG, or state-specific methodologies)
• Represent risk adjustment Medicaid informatics in executive forums
• Oversee health plan performance using advanced analytics and use proactive data insights to drive strategies and evidence-based decision-making
• Lead development of scalable data pipelines and reporting frameworks using claims, encounters, pharmacy, and clinical data
• Ensure accuracy, integrity and completeness of Medicaid encounter submissions and data
• Establish and oversee processes to ensure accuracy, completeness, and integrity of risk capture
• Direct suspecting logic development, gap identification, and prioritization strategies for operational programs and interventions
• Lead and develop a high-performing, multidisciplinary team spanning informatics, risk analytics, reporting, and operational program support

Lead Director, Healthcare Medicaid Risk Adjustment Analytics

• Participate in a structured leadership training program focused on clinical operations and regulatory compliance
• Shadow and support Clinical Directors with day‑to‑day clinical, staffing, scheduling, and operational responsibilities
• Assist in reviewing resident care plans, medication management, and health assessments to ensure quality care
• Support quality assurance initiatives and help meet clinical performance metrics
• Learn and assist with state and federal regulatory compliance, audits, and documentation accuracy
• Support hiring, training, and mentorship of Wellness team members
• Collaborate with interdisciplinary teams to deliver person‑centered care
• Communicate with residents and families regarding care plans and health updates
• Assist with scheduling, staffing plans, inventory management, and basic operational planning
• Engage in ongoing professional development in geriatric care and clinical leadership

Clinical Director – Training

• This position supports the clinical vision for the health plan(s) for all lines of business (Medicaid, Medicare, and Commercial) and implements programs to support this vision.
• Provides clinical leadership to the interdisciplinary Medical Management team, which includes clinical/medical oversight of clinical team members and consultation and training with care managers in order to address cost and quality of care.
• Provides day to day physician oversight to an assigned interdisciplinary UM team, including regular involvement in the case management of at-risk cases and medical necessity decisions.
• Follows high risk cases throughout treatment continuum from inpatient, rehabilitation, partial hospitalization, outpatient and other levels of care.
• Ensures that persons with severe, complex, and/or treatment resistant illnesses receive medically necessary coordinated care throughout the episode of treatment.
• Develop and implement a Utilization Management program and action plan, which includes strategies that ensure a high quality of patient care, ensuring that patients receive the most appropriate care at the most cost-effective setting.

Medical Director – Behavioral Health

• 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 jobs in Idaho

See all jobs on JobTailor

Medical Director – Addiction Medicine, Telehealth

Director, Rx Clinical Operations

Lead Director, Healthcare Medicaid Risk Adjustment Analytics

Clinical Director – Training

Medical Director – Behavioral Health

Medical Director – Pain Medicine