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

• 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

Appeals Medical Director – Cardiology

• Responsible for appeal reviews for physical health medical services
• Ensure appropriate and cost-effective medical care is received
• May develop and implement programs to improve quality, cost, and outcomes
• Provide clinical consultation and serve as clinical/strategic advisor
• Identify cost of care opportunities
• Supports clinicians for timely and consistent responses to members and providers
• Provides guidance for clinical operational aspects of a program
• Conduct peer-to-peer clinical case reviews
• Serves as a resource and consultant for other areas of the company
• May represent the company to external entities and serve on committees
• Interprets medical policies and clinical guidelines
• May develop and propose new medical policies
• Leads, develops, directs, and implements clinical and non-clinical activities

Appeals Medical Director – Urology

• 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

• 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

• Conduct electronic review of escalated cases against medical policy criteria
• Complete initial determination of cases, review of appeals and grievances, and other reviews as assigned
• Compose clear and concise rationales for member and provider determination notifications
• Participate as a member of the CMDM multidisciplinary team
• Advise multidisciplinary team on cases that require physician expertise
• Actively manage projects and/or participate on project teams that require a physician subject matter expert

• 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

• Support BeOne Medicines pre-clinical and clinical pipeline development by coordinating external collaborations
• Establish and maintain scientifically credible peer-to-peer scientific relationships with national & regional opinion leaders
• Facilitate & monitor strategic partnerships with scientific/clinical experts
• Provide balanced, accurate information to regional formulary decision makers
• Identify and vet investigators, nominate sites to Clinical Operations for company-sponsored clinical trials
• Assist in the development and execution of clinically relevant regional medical meetings
• Serve as an internal resource of clinical and scientific information from medical interactions
• Build strong relationships with internal experts

Field Medical Director – Solid Tumor, Breast and Lung

• 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

• Ensure timely and consistent responses to members and providers related to precertification, concurrent review, and appeal request.
• Primarily responsible for Utilization Management, including prior authorization and precertification as well as concurrent review.
• Cases could focus on inpatient or outpatient, acute and post-acute as well as peer to peer calls and first level appeals.
• Participate in a rotating on call schedule to provide weekend and holiday coverage.

Medical Director – Medicaid

• Develops and implements cost of care initiatives based on segmentation and other population health drivers
• Partners with Cityblock’s Data and Analytics and Population Health teams to understand and map solutions to address drivers of utilization
• Leads clinical quality improvement initiatives that may span multiple locations
• Decreases unnecessary hospitalizations, emergency room visits, and unnecessary speciality referrals
• Participates in case conferences to bring a psychiatric lens to member care
• Supports care team in developing members’ care plans when behavioral health interventions apply
• Guides clinical team on complex clinical cases
• Conducts psychiatric evaluations for members referred to BH or identified through segmentation
• Conducts visits for medication bridging for any member
• Prescribes, as clinically indicated, psychiatric medications
• Completes comprehensive, compliant diagnosis capture
• Works with members until they are stabilized in the community
• Supports members in achieving their behavioral health care plan goals

Medical Director, Behavioral Health

• Plan and execute medical strategy and engagement for appropriate assigned customers within a territory, compliantly coordinating with other Pfizer colleagues as needed to achieve medical objectives
• Maintain required level of knowledge of relevant TA/disease states and Pfizer medicines, providing therapeutic area/product information to both internal and external stakeholders as needed
• Serve as a conduit and resource for medical information and customer insights, providing requested information to HCPs as allowed by Pfizer guidance and sharing customer viewpoints with Pfizer as appropriate
• Understand the priorities of Pfizer Medical Affairs to contribute to medical content strategy development and execute aligned Field Medical tactics
• Maintain effective and appropriate communication and collaboration among headquarters medical colleagues and other Pfizer Field Medical colleagues
• Demonstrate expertise in communication across multiple channels, including, but not limited to, live and virtual presentations in small or large settings, written communication, and telephone or virtual conversations
• Optimize patient centricity of medical communications and deliverables, incorporating health literacy and cultural awareness principles to ensure that patients remain the ultimate focus
• Deliver approved medical content about Pfizer medicines and relevant topics in the designated therapeutic area
• Identify and seek medical engagement from priority customer segments in assigned TA
• Provide truthful, accurate, and scientifically supported information in response to direct unsolicited medical requests from HCPs in a manner that complies with all applicable Pfizer guidelines, policies, and procedures
• Field relevant inbound queries from HCPs via established triage process
• In collaboration with Global Medical Affairs colleagues, partner with Oncology Research & Development and Global Product Development (GPD) in the identification of potential sites for Pfizer-sponsored clinical trials, including identification of sites serving under-represented patient populations in trials
• Appropriately provide medical support throughout the Investigator Sponsored Research (ISR) process
• Cultivate research and TA expertise, including familiarity with latest congress data and disease state literature
• Provides asset leadership
• Understand the principles of study design, methodology, data analysis, and interpretation and communicate these concepts with customers
• Strong territory leadership
• Reactively and proactively communicate with local Patient Advocacy Group(s), as appropriate, in close collaboration with Corporate Affairs and HQ Medical Affairs
• Deliver insights on local patient organization structure, capabilities, and patient population needs
• Serve on Medical and/or TA and asset cross-functional committees, as appropriate
• Represent Pfizer Medical Affairs leadership with clinical/professional associations and/or societies, consistently demonstrating medical professionalism in all interactions
• Mentorship – Onboarding partner, ad board and study lead mentor
• Participate in special projects as needed

Oncology Field Medical Director – Non-MD

• Oversee day-to-day site operations for all onsite/offsite staff
• Collaborate with CEO to prepare and manage a budget
• Maintain high quality clinical skills and ensure clinical coverage
• Facilitate ongoing clinical collaboration and participate in meetings
• Manage overall scheduling of consumers and oversee timeliness of required documentation

Clinical Director – Part-Time

• Completing medical necessity reviews for substance use disorder cases
• Supporting clinicians for timely responses to members and providers
• Providing clinical operational guidance
• Conducting peer-to-peer clinical reviews

Medical Director – Addiction Medicine

• Develop, implement, educate and monitor clinical programs that are intended to meet Professional Nursing Standard of Care and Nursing Standard of Practice.
• Advise and support facilities in their efforts to comply with State and Federal Survey Regulations for Medicare and Medicaid Licensure and Certification.
• Assist facilities in response to endemic, epidemic, & pandemic disease outbreaks.
• Assist the Administrator and/or DON in writing plan of corrections (POC) and Allegation of Compliance (AOC) for any state and federal survey deficiencies cited.
• Monitor facilities compliance with POC’s submitted to State Health Department (HD) for recertification of Medicare and Medicaid License.
• Provide oversight for reportable events that are submitted to HD.
• Provide training to facility Administration and/or staff as needed.
• Conduct monthly Regional DON meetings for clinical program training and DON development.
• Conduct visits to the facility to assess and train clinical staff.
• Attend regional meetings and give clinical insight as requested by the RDO.
• Develop Regional tracking and trending reports for clinical metrics regarding CMS 5-star rating.
• Assist facilities in their clinical risk management efforts.

See all jobs on JobTailor

Medical Director – Pain Medicine

Medical Director – Oncology

Appeals Medical Director – Cardiology

Appeals Medical Director – Urology

Medical Director, Clinical Regulatory Affairs

Medical Director – Medical Genetics, Genomics

Medical Director

Medical Director – Genetic Testing, Oncology

Field Medical Director – Solid Tumor, Breast and Lung

Oncology Field Medical Director – MD

Medical Director – Genetic Testing, Oncology

Medical Director – Medicaid

Medical Director, Behavioral Health

Oncology Field Medical Director – Non-MD

Clinical Director – Part-Time

Medical Director – Addiction Medicine

Regional Director – Clinical Services