Medical Director

• Oversee a team of several medical writers within assigned therapeutic areas and client accounts
• Review and revise all medical content to ensure strategic integrity, scientific accuracy, and quality execution of deliverables
• Counsel clients in the development of various medical strategies and medical communication tactics
• Drive contributions to strategic planning initiatives and tactical ideation
• Ensure all deliverables meet the highest standards of scientific accuracy, consistency, and compliance
• Understand project scopes and statuses and partner with project leads
• Support senior medical and operations leaders by providing input into staffing needs
• Contribute to business growth by identifying organic growth opportunities

• Oversee a team of medical writers within assigned therapeutic areas and client accounts
• Review and revise medical content to ensure scientific accuracy and alignment with client strategies
• Counsel and serve as integral partner to clients in the development of various medical strategies
• Serve as the primary medical point of contact for clients on projects and deliverables
• Ensure all deliverables meet the highest standards of scientific accuracy, consistency, and compliance
• Understand project scopes and statuses and partner with account/project leads
• Contribute to business growth by supporting the development of new business proposals

Associate Medical Director

• Assist the Vice President of Medical Affairs to direct and coordinate the medical affairs functions for the business unit
• Oversee the denials and appeals department
• May manage other medical directors
• Provide medical leadership for all utilization management, pharmacy, case management, disease management, cost containment, and medical quality improvement activities
• Perform medical review activities pertaining to utilization review, quality assurance, and medical review of complex, controversial, or experimental medical services
• Support the effective implementation of performance improvement initiatives for capitated providers
• Assist VPMA in planning and establishing goals and policies to improve quality and cost-effectiveness of care and service for members
• Utilize the services of medical and pharmacy consultants for reviewing complex cases and medical necessity appeals
• Participate in provider network development and new market expansion as appropriate

Senior Medical Director – YouthCare

• Responsible for medical and scientific oversight of clinical trials in Internal Medicine
• Provides timely, study-related medical information and guidance
• Conducts and documents periodic safety data review and ongoing clinical/medical data review
• Represents the study team in internal protocol review governance submissions and interactions
• Develops site selection criteria and ensures protocol training is delivered to site-facing colleagues
• Ensures TMF compliance for clinical documents
• Develops clinical guidance and reviews safety data

Clinical Development Medical Director, MD Required

• Develop and execute compelling scientific content
• Analyze complex clinical and scientific data
• Counsel clients in medical strategies and medical communications
• Serve as the primary point of contact for clients
• Ensure deliverables meet scientific accuracy and compliance standards
• Provide leadership and mentorship to medical writers
• Contribute to business growth by supporting new business proposals

• responsible for assigned aspects of medical policies and programs
• performs medical reviews
• interacts with the provider communities for assigned areas

• Responsible for appeal reviews for physical health medical services
• Ensure the appropriate and most cost-effective medical care is received
• Develop and implement programs to improve quality, cost, and outcomes
• Provide clinical consultation and serve as clinical/strategic advisor to enhance clinical operations
• Identify cost of care opportunities
• Supports clinicians to ensure timely and consistent responses to members and providers
• Provides guidance for clinical operational aspects of a program
• Conduct peer-to-peer clinical case reviews with attending physicians or other ordering providers
• Serve as a resource and consultant for other areas of the company

Medical Director – Oncology

• 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

• The Director of Clinical Services (DCS) is accountable for clinical and operational excellence within a defined book of business in an Envision Physician Services operating unit.
• This position drives improvements in patient care processes and outcomes by partnering with local practice medical leadership and front-line clinicians.
• Within a defined book of business, the DCS balances the needs and opportunities of a client with internal EMG relationships throughout their portfolio.
• The DCS identifies areas of opportunity within their book of business and works collaboratively with operating unit leadership team to provide partnership to medical directors and clients towards performance enhancement and goal achievement.
• The DCS drives implementation of clinical quality, service line clinical operations, corporate initiatives.

Director of Clinical Services

• Ensures timely completion of clinical case reviews for their board-certified specialty
• Makes physician to physician calls to gather medical appropriate information in order to make medical necessity determinations for services requested
• Makes medical necessity determinations for grievance and appeals appropriate for their specialty
• Ensures consistent use of medical policies when making medical necessity decisions
• Brings to their supervisors attention, any case review decisions that require Medical Director review or policy interpretation

Associate Medical Director – Outpatient Rehab

• 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

• Provide clinical interpretation and determinations on the medical appropriateness of services delivered by healthcare professionals, including the application of evidence-based guidelines.
• Make independent, timely, and defensible medical decisions on complex appeal cases, exercising professional judgment with minimal supervision.
• Collaborate with cross-functional teams—including legal, compliance, and clinical operations—to address and resolve grievances and appeals.
• Participate in quality improvement initiatives, identifying trends in grievances and appeals and recommending process improvements.
• Serve as a clinical resource for grievance and appeals staff, providing guidance and education as needed.
• Maintain current knowledge of Medicare regulations, managed care requirements, and industry best practices relevant to appeals and grievances.
• Support Humana’s commitment to continuous improvement in consumer experience, ensuring fair, consistent, and customer-focused outcomes.
• Participate in internal and external audits as required and respond to regulatory inquiries as needed.
• Adhere to all confidentiality and HIPAA requirements in handling protected health information (PHI).

Medical Director – Grievances & Appeals

• Perform concurrent and prior authorization reviews with peer to peer coverage of denials.
• Perform appeals in their 'base plans' and may round robin based on 'same or similar specialty' needs.
• Perform pharmacy reviews.
• Participate in and be able to lead rounds.

Medical Director – Duals Center of Excellence

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• Determines the medical necessity of requests using clinical criteria
• Performs physician-level case review of oncologic utilization requests
• Conducts peer-to-peer consultation with ordering physicians, physician assistants and advanced practice nurses regarding established guidelines and accepted standards of care as it relates to treatments, procedures, imaging and appropriate sites of service
• Provides education regarding applicable clinical criteria and discusses clinically appropriate options
• Performs first level provider appeals for coverage decisions
• Provides support and education to internal clinical and non-clinical staff regarding the principles associated with appropriate diagnoses, treatments, and management related to these specialties
• Participates in physician team meetings
• Participates in groups that develop, revise and enhance clinical appropriateness guidelines

Medical Director – Genetic Testing, Oncology

• Provides medical monitoring on one or more clinical trials
• Provides timely, study-related medical information and guidance
• Conducts and documents periodic safety data review and ongoing clinical/medical data review
• Reviews required safety text for the Informed Consent Document
• May independently lead clinical execution of one or more studies
• Represents the study team in internal protocol review governance submissions
• Ensures development of Study Informed Consent Documents
• Develops site selection criteria and provides clinical input to selection of sites

• Population Health program clinical leadership: This physician or Advanced Practice Provider will be the clinical leader for a set of programs within the Population Health and Centralized Services Teams.
• Liaison to other clinical and operational leaders: Patients receiving care through these clinical programs will, in most cases, also be receiving primary care through Oak Street's network of primary care centers.
• Organizational Strategy and Collaboration: The Medical Director for Population Health will participate in organization wide planning and strategy including helping vet new opportunities, plan staffing, and hiring staff.
• Drive Culture: At Oak Street, we foster a culture of innovation and open dialogue, and we work with urgency.

Medical Director – Health Care Delivery, Pop Health

• Provides medical monitoring on one or more clinical trials
• Provides timely, study-related medical information and guidance
• Contributes to medical assessments of Quality Events
• Conducts and documents periodic safety data review and ongoing clinical/medical data review
• Reviews Required Safety Text for the Informed Consent Document
• Provides clinical support for one or more studies
• May provide input to the protocol design document
• Supports the study team in internal protocol review governance submissions and interactions
• May develop Study Informed Consent Documents
• Provides clinical input to the development of the Statistical Analysis Plan
• Ensures all clinical queries are appropriately addressed in support of database lock
• Tracks and reconciles Serious Adverse Events
• Contributes to site selection criteria
• May serve as a clinical point of contact with investigators and study team for questions relating to clinical aspects of the protocol

Clinical Development Medical Director – Associate Director

• Plan and execute medical strategy and engagement for assigned customers
• Maintain knowledge of relevant TA/disease states and Pfizer medicines
• Serve as a resource for medical information and customer insights
• Understand priorities of Pfizer Medical Affairs
• Maintain effective communication among medical colleagues
• Deliver approved medical content about Pfizer medicines
• Identify and seek medical engagement from priority customer segments
• Provide truthful, accurate, and scientifically supported information to HCPs
• Facilitate medical support throughout Investigator Sponsored Research (ISR) process
• Cultivate research and TA expertise
• Represent Pfizer Medical Affairs leadership

Oncology Field Medical Director – MD

• Determines the medical necessity of requests using clinical criteria
• Performs physician-level case review of oncologic utilization requests
• Conducts peer-to-peer consultation with ordering physicians
• Provides education regarding applicable clinical criteria
• Performs first level provider appeals for coverage decisions
• Provides support and education to internal clinical and non-clinical staff
• Participates in physician team meetings
• Participates in groups that develop, revise and enhance clinical appropriateness guidelines

See all jobs on JobTailor

Medical Director

Associate Medical Director

Senior Medical Director – YouthCare

Clinical Development Medical Director, MD Required

Associate Medical Director

Medical Director

Medical Director – Oncology

Clinical Director – Training & Quality

Director of Clinical Services

Associate Medical Director – Outpatient Rehab

Medical Director, Clinical Regulatory Affairs

Medical Director – Grievances & Appeals

Medical Director – Duals Center of Excellence

Medical Director

Medical Director – Genetic Testing, Oncology

Clinical Development Medical Director, MD Required

Medical Director – Health Care Delivery, Pop Health

Clinical Development Medical Director – Associate Director

Oncology Field Medical Director – MD

Medical Director – Genetic Testing, Oncology