Medical Director

• Provide physician leadership in the development, implementation, and ongoing evaluation of evidence-based clinical guidelines, medical policies, and utilization management protocols to support high-quality, clinically appropriate decision-making.
• Ensure clinical programs, utilization review activities, and medical management processes align with current standards of care, evidence-based medicine, accreditation requirements, and applicable federal and state regulations.
• Serve as the clinical authority for complex, high-risk, or escalated utilization review cases by providing medical expertise, benefit interpretation, and final medical necessity determinations as appropriate.
• Promote consistency, accuracy, and defensibility in medical decision-making by applying sound clinical judgment and established medical necessity criteria across all review activities.
• Collaborate with Clinical Operations, Compliance, Legal, and executive leadership to develop, review, and revise clinical and administrative policies, medical necessity guidelines, and benefit interpretation criteria.
• Monitor changes in clinical practice guidelines, healthcare regulations, payer requirements, and industry best practices, recommending updates to organizational policies and review processes as necessary.
• Provide physician oversight for quality and performance initiatives by reviewing medical management outcomes, analyzing quality metrics, and participating in quarterly Quality Committee meetings and reporting.
• Participate in internal audits, accreditation activities, regulatory reviews, and quality improvement initiatives to ensure compliance with organizational standards and continuous operational excellence.
• Partner with operational leadership to ensure clinical standards are effectively integrated into utilization review workflows, promoting efficient, evidence-based, and member-focused medical management.
• Provide clinical consultation and recommendations regarding post-service medical necessity determinations, appeals, and other medically complex cases requiring physician review.
• Serve as a trusted clinical resource and advisor to physicians, nurses, utilization review staff, and cross-functional business partners by providing education, guidance, and consultation on medical policy and clinical best practices.
• Participate in interdisciplinary committees, physician advisory groups, and organizational meetings to provide clinical insight and support strategic initiatives.
• Foster collaborative relationships with internal and external stakeholders to promote quality outcomes, regulatory compliance, and continuous improvement across medical management programs.
• Perform other duties as assigned.

Medical Director – Part Time

• Provides strategic medical and scientific knowledge (Cardiovascular, Renal, Metabolic, and/or Liver Disease) and supports the design, initiation, execution, completion, and interpretation of a clinical study
• Is accountable for study designs
• Is accountable to deliver medical information, answers, and clarifications to Regulators, Ethic Committees, Marketing Companies, Investigators/Sites
• Often works as a Global Clinical Head (GCH) delegate across several studies (e.g. a paediatric programme, or a set of mechanistic/differentiating studies)
• Can be the clinical representative on indication Global Product Teams and/or other sub-teams
• Has the knowledge to work across projects, with a fast learning curve when moving into new disease area
• Is accountable to the Global Clinical Head (GCH) or delegate for the medical aspects and designs of studies
• Is responsible for driving decisions within Study Team (ST) remits together with other ST members and for solving medical issues in the study team
• Is accountable for the medical and ethical components of studies including patient safety on a study level in compliance with GCP
• Is accountable for delivery of the clinical components of all relevant study documents (e.g Protocol, Amendments, Statistical Analysis Plan, Informed Consent Form, Case Report Forms, and Safety and Risk-Based Monitoring Plans)
• Is accountable for ensuring that safety surveillance on a study level including the process for Adverse Events (AE)/ Serious AE reporting, the querying of missing/unclear data, the review of blinded safety data, and the escalation to the GCH/Global Safety Physician when needed.
• Is medically accountable for international investigator meetings, and supports Marketing Companies (MC) in national activities
• Approves (with the GCH) the Clinical Study Report; including preparation and production thereof (Introduction, Results, Discussion).
• Is accountable for ST induction and education of new members in the study team, as well as others involved in the study
• Collaborates seamlessly and efficiently with global colleagues at other R&D sites
• May be accountable to GCH (or delegate) and leadership for identifying risks and proposing mitigation strategies to deliver successful Phase II, III, IV or Life Cycle Management studies
• Stays updated on relevant scientific literature
• Delivers analyses of clinical data in a balanced, statistically sound fashion, to drive interpretations and further idea generation
• Serves as a source of medical expertise for the Product Team, in analyses and interpretation of medical data
• Maintains a high degree of understanding and awareness on new and emerging medical development, globally.
• Works with international colleagues and with external Alliance partners on development initiatives and regulatory issues
• Applies strategic intent of AstraZeneca when working with Alliance partners, Regulatory Authorities, payers, opinion leaders, prescribers and consumers of AstraZeneca products
• Able to provide guidance for investigator-initiated trials in cooperation with regional marketing companies
• Accountable for building trustworthy relationships with steering committees/executive committees with AROs/CROs
• Maintains strong networks globally with KEEs, prescribers, regulators and payers

Senior Director, Global Clinical Program Lead

• Responsible for the 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
• Serves as a resource and consultant to other areas of the company
• May 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

• Lead the design of clinical trials by developing study protocols and selecting endpoints
• Provide strategic oversight for clinical trial execution and monitor study progress
• Drive the creation of key study-level documents such as protocols and regulatory submissions
• Address regulatory/health authority inquiries and ensure compliance with guidelines
• Develop and oversee the Clinical Development Plan and Integrated Evidence Plan
• Collaborate with cross-functional teams to ensure seamless execution of clinical development programs
• Mentor junior team members within the clinical science organization

Director, Clinical Science

• 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

• Collaborate with physicians, scientists, regulatory professionals, biostatisticians, executive staff, and others in a complex matrix environment to develop and execute phase 1-3 interventional clinical trials
• Use medical expertise to contribute to the end-to-end (protocol concept to final study report) and timely delivery of clinical trials while ensuring patient safety, scientific integrity, and consistency with the clinical development strategy
• Ensure high-quality protocol development aligned with the early Clinical Development Plan to effectively determine a medicine’s potential efficacy, safety profile, key areas of product differentiation and value to patient in the shortest possible timeframe
• Assume medical responsibility for early phase clinical trials with active participation in real-time medical monitoring, including patient eligibility assessment, study design questions, and addressing urgent safety questions
• Assume responsibility for medical review of clinical trial data, both directly and/or via oversight of delegated medical review
• Review/monitor safety data in collaboration with pharmacovigilance group for active clinical studies

Medical Director, Oncology Clinical Development

• The Associate Director, Medical has a deep understanding of the client’s business and demonstrates critical thinking and confidence
• Provide strategic input to guide creation of clinically relevant educational content and ensure effective use of clinical data to reach strategic brand objectives
• Independent scientific content development including analysis and interpretation of clinical data across a wide range of project types
• Conduct literature searches, proactively monitor competitive landscape and perform competitive analyses
• Establish strong relationships with clients and proactively seek to contribute and collaborate in client meetings
• Partner with internal teams to create compelling peer-to-peer educational content and engagement projects for healthcare professionals
• Establish close partnership with copy, art and digital teams to create interactive, engaging programs utilizing scientific storytelling techniques and unique data visualization
• Collaborate to create and communicate Intouch’s POV and recommendations with clients
• Play key role on team to educate team members on disease state, clinical trials, treatments and competition
• Support submissions for client medical/regulatory approval processes

Associate Director, Medical – PhD, MD, Pharma Ad Agency Experience Required

• Develops professional relationships and engages with national and regional SLs to ensure access to company-approved medical and scientific information on areas of therapeutic interest and Company products
• Conducts peer-to-peer scientific discussions and maintains a reliable presence with those SLs to ensure they have a medical contact within the company
• Addresses scientific questions and directs SL inquiries on issues outside of scope (e.g., grants) to appropriate company resources consistent with applicable policies
• Maintains current knowledge and comprehension of dynamic scientific and clinical environment in the Company's Areas of Interest (AOI) for your specific therapeutic area
• Initiates discussions with SLs and/or potential investigators that include scientific/data exchange within our AOI to determine the alignment with our research strategies, studies concepts, scientific merit, and qualifications for a specific compound or trial
• Recommends study sites and identifies potential investigators to participate in phase II-IV clinical development programs, conducts Site Initiation Visits (SIVs), and detects barriers to patient enrollment and retention efforts to achieve study milestones
• Engages in scientific congresses and medical meetings, facilitates scientific and data exchange for both Company and competitor data
• Gathers feedback, data, or information during routine activities that can help the company better comprehend medical or scientific needs, priorities, or concerns of SLs and/or patients

Regional Medical Scientific Director – Medical Science Liaison, Immunology

• Manage the Health Plan Medical Directors
• Provide clinical support for the Health Management Utilization Management, Care Management and Quality teams
• Drive the development, promotion and delivery of high quality, evidence-based utilization and care management programs and processes
• Lead programs and reviews to support effective medical expense management, medical quality programs and outcomes, and programs to manage medical utilization trends such as inpatient, Emergency Department, Site of Care, pharmacy and radiology
• Achieves defined clinical outcomes, affordability goals and growth targets
• Works closely across the HP to ensure compliance with government program regulations, including management of clinical appeals and grievances with sound clinical evidence and advice
• Works closely with the Medical Directors and the Director of Medical Economics to devise analytic approaches that support and measure strategic development and sound clinical programs
• Provides clinical insight into data to assist in development of and measurement of tailored interventions that address clinical trends and opportunities
• Develops key strategies to address opportunities in medical expense management
• Identifies opportunities for improvement in the quality of care that create competitive advantage for Martin’s Point as it relates to the health of populations served
• Accountable for appropriate Utilization Management processes
• Assists and provides clinical input into the evolution of care/utilization management, quality, and pharmacy related programs
• Contributes to and advises in product design and the Medicare bid processes
• Contributes to and advises in areas of clinical integration as it relates to risk adjustment
• Serves as a central HP leader aligning medical, clinical, and operational functions to achieve seamless and thorough solutions related to Medical and Payment Policies
• Actively engages with quality, network, and compliance teams to help drive performance

Vice President, Medical Director of Clinical Programs

• Be the Voice of Clinical Trust Represent Elsevier as a senior clinical authority in high-impact customer engagements, partnerships, global forums and digital marketing.
• Build enduring relationships with healthcare leaders, academic institutions, and professional societies.
• Serve as a thought leader in clinical AI, evidence-based practice, and digital health transformation.
• Ensure that products are optimized to deliver utmost clinical value to users by evangelizing clinician needs.
• Define Clinical Value at Scale Establish what “great” looks like for clinical value across our solutions—from decision support to Competency Management.
• Define a holistic content strategy to evolve current products from providing reference information to providing advanced clinical decision support.
• Assess content data strategy and utilization to inform overarching roadmaps.
• Ensure our products deliver measurable, real-world impact for clinicians and patients.
• Create consistent standards for evidence, transparency, and trust across the portfolio.
• Own how critical clinical decisions are made, escalated, and resolved across the business.
• Act as the ultimate arbiter to ensure clinical efficacy and quality aligns with technical or commercial priorities.
• Partner with product and data science teams to ensure innovation is grounded in clinical best practice and overall efficacy.
• Help shape industry standards for responsible, evidence-based AI.
• Ensure a consistent and trusted clinical voice across the entire clinician journey.

Global Chief Medical Officer

• Supports clinicians to ensure timely and consistent responses to members and providers
• Provides guidance for clinical operational aspects of a program
• Conducts peer-to-peer clinical reviews with attending physicians or other providers to discuss review determinations
• Serves as a resource and consultant for other areas of the company
• May chair company committees
• Interprets medical policies and clinical guidelines
• Identifies and develops opportunities for innovation to increase effectiveness and quality

Medical Director – Physical Medicine and Rehabilitation

• 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

• 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

• Responsible for the appeal reviews for physical health medical services
• Supports clinicians to ensure timely and consistent responses to members and providers
• Provides guidance for clinical operational aspects of a program
• Conducts peer-to-peer clinical case reviews with attending physicians
• Serves as a resource and consultant for other areas of the company
• May chair company committees
• Interprets medical policies and clinical guidelines
• Identifies and develops opportunities for innovation to increase effectiveness and quality

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