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

• 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

• 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 – Medical Genetics, Genomics

• Oversee multiple hospital locations within the Central Division (MN, KS, WI).
• Identify, oversee, and develop medical leaders to ensure optimal clinician productivity and engagement.
• Foster a collaborative relationship between the support team and hospitals.
• Monitor reports on operating costs within functional areas.
• Ensure standards for medical quality, patient safety reporting, equipment, and clinician productivity/performance are met.
• Partner with assigned Vet Relations team to collaborate on pDVM referral strategies that impact assigned markets.

See all jobs on JobTailor

Senior Medical Director

Medical Director – Pain Medicine

Director of Clinical Services

Medical Director – Medical Genetics, Genomics

Veterinary Group Medical Director