Medical Director

• Provide direct leadership for various IT clinical domains.
• Serve as primary IT lead for EMR planning and execution.
• Collaborate closely with implementation partners and QHC leadership.
• Act as key liaison with governance teams ensuring effective EMR implementation.

Director of Ancillary, Clinical Systems

• Ensure timely completion of all medical appointments, including new patient induction, follow-ups, medical histories, and laboratory testing.
• Review laboratory results and medical documentation from other providers, managing patient care according to best practices.
• Ensure medical providers prescribe and titrate medication-assisted treatment appropriately.
• Ensure patients receive adequate services for communicable diseases, including risk evaluation, testing, and counseling.
• Conduct chart and dashboard reviews to ensure adherence to medical policies.

• Ensure timely completion of all medical appointments, including new patient induction, follow-ups, medical histories, and laboratory testing.
• Review laboratory results and medical documentation from other providers, managing patient care according to best practices.
• Ensure medical providers prescribe and titrate medication-assisted treatment appropriately.
• Ensure patients receive adequate services for communicable diseases, including risk evaluation, testing, and counseling.
• Ensure availability to respond to treatment center staff and emergency care providers for patient consultations.
• Conduct chart and dashboard reviews to ensure adherence to medical policies.
• Ensure treatment centers meet accreditation standards related to medical, health, and safety requirements.
• Provide medical supervision and maintain records for APPs as required by state law.
• Participate in peer reviews for advanced practitioners and program physicians to comply with accrediting agency requirements.
• Collaborate with physicians, clinics, and hospitals involved in patient care.
• Provide consultation to medical, clinical, and administrative staff for patient treatment planning.
• Conduct in-service training and community education on substance abuse-related mental health topics.
• Assist in developing affiliations and relationships with community-based medical providers.
• Provide input on annual performance reviews for the Center Director and nursing team members.
• Assist in activities assigned by Senior Management.

Medical Director – Part Time or Full Time

• 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

• support care management, quality, utilization management, credentialing, pharmacy, health policy implementation, technology assessment and risk management activities
• Completes care management case review for cases involving medical necessity review
• Completes appeal case review for cases involving medical necessity review
• Partners to establish priorities as appropriate for improving service at the point of care
• Completes quality of care complaint reviews for cases involving clinical aspects or clinical/service aspects
• Participates in rotation to above Committee Participation

Medical Director – Clinical Ops Case Review

• Drive market and customer insights for our healthcare talent and verification solutions.
• Act as the organization's subject matter expert, using segmentation and competitive analysis to identify differentiated opportunities and lead validation efforts via customer feedback and advisory boards.
• Prioritize healthcare-specific opportunities, including strategic partnerships and integrations.
• Define unique value propositions that meet complex compliance and market needs, advise on buy/build/partner strategies, and lead commercial model development.
• Own the healthcare product roadmap and build business cases for new concepts.
• Drive cross-functional alignment on positioning, pricing, and promotion across all distribution channels.
• Translate complex compliance and administrative requirements into actionable requirements and acceptance criteria.
• Influence frictionless UX that balances industry guardrails with the distinct operational needs of healthcare buyers and background screening partners.
• Partner with Marketing, Sales, and Success to lead feature launches.
• Manage pilot programs, iterate on solutions based on feedback.
• Develop training and compelling narratives that articulate operational ROI, specifically addressing the unique value drivers for background screening partners versus clinical/hospital executives.
• Manage portfolio financial performance, ensuring revenue and margin targets are met.
• Drive engagement and adoption by interpreting usage data and customer feedback to guide feature enhancements and lifecycle decisions.

Senior Director, Healthcare Product Manager

• Use your medical background, experience, and judgement to make determinations whether requested services, requested level of care, or requested site of service should be authorized, with all work occurring within a context of regulatory compliance and assisted by diverse resources
• Learn Medicaid requirements and understand how to operationalize this knowledge in your daily work assigned cluster
• Work includes computer-based review of moderately complex to complex clinical scenarios, review of all submitted clinical records, prioritization of daily work, communication of decisions to internal associates, and possible participation in care management
• Conducts discussions with external physicians by phone to gather additional clinical information or discuss determinations through the peer-to-peer process
• May speak with contracted external physicians, physician groups, facilities, or community groups to support regional market priorities
• Supports Humana values including working collaboratively on a team throughout all activities
• Flows to work as needed within cluster as needed for vacations, weekends and holidays coverage.

Behavioral Health Medical Director, Medicaid

• 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

• 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

• Determines the medical necessity of requests using clinical criteria
• Performs physician-level case review of surgical 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 interventional and non-interventional 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 of conditions and surgical procedures
• Participates in physician team meetings
• Participates in groups that develop, revise and enhance clinical appropriateness guidelines

Medical Director – Surgery

• Bring knowledge and skills to the business of Blue Cross North Carolina
• Support value-based strategies and clinical operations
• Develop and drive strategy for varied Health Care initiatives
• Partner with internal and external clients to support agreements
• Evaluate and manage vendors to align with strategic direction
• Gather and analyze data for health outcomes improvement
• Represent BCNC through presentations and leadership

Medical Director jobs in Kentucky

See all jobs on JobTailor