Medical Director

• Translate enterprise clinical global talent strategy into execution through structured, wave-based implementation plans that deliver measurable value across cost, quality, and scalability
• Partner across Clinical, Enterprise Strategy, Global Talent, and external vendors to define and evolve the global clinical operating model, including scope such as utilization management, case management, pharmacy support, and administrative services
• Lead clinical role assessment and governance processes to determine optimal role location, ensuring alignment with licensure requirements, regulatory standards, accreditation needs, and client contract obligations
• Establish clear guardrails and scope boundaries by identifying which clinical roles are appropriate for globalization and documenting rationale to support decision-making and compliance reviews
• Design and lead clinical transition planning, including vendor engagement, operating model selection (BPO, captive, or hybrid), and readiness assessments to support safe, compliant implementation
• Ensure transition designs account for clinical-specific requirements such as credentialing, licensure, supervision structures, and enhanced quality and audit checkpoints
• Build and scale global clinical and non-clinical teams by partnering with Talent Acquisition and HR to deliver recruiting, credentialing, and onboarding pipelines aligned to market supply and regulatory expectations
• Establish clinical leadership models, including supervision layers and on-site leadership roles, to support safe delivery and clinical governance at scale
• Implement end-to-end clinical process ownership with embedded quality metrics, productivity measures, service-level agreements, and patient safety indicators to ensure consistent outcomes
• Ensure readiness for audits, accreditation, and client assurance processes, including data privacy, regulatory adherence, and quality performance standards
• Design governance structures and value tracking methodologies that measure role transitions, cost-to-serve improvements, time-to-proficiency, and clinical quality outcomes
• Proactively identify and escalate risks related to regulatory compliance, workforce readiness, and clinical quality, enabling timely resolution and continuous improvement
• Drive stakeholder alignment and change management across clinical leaders, business units, Legal, Compliance, and Enterprise stakeholders to support successful global hub implementation
• Develop and deliver executive-level communications and presentations that clearly articulate strategy, progress, and value realization of the clinical global talent model

Global Clinical Program Strategy Director

• 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

• Provides enterprise leadership for U.S. Employer Medical Customer Service organization
• Oversees the strategic direction, operational performance, and transformation agenda across all medical service lines
• Partners extensively with enterprise leaders to define and execute strategies that improve customer experience, enhance efficiency, optimize service delivery, and accelerate business performance
• Establishes multi-year operational strategies, leads complex transformation initiatives, drives adoption of emerging technologies and AI-enabled capabilities
• Champions talent development, organizational effectiveness, and change leadership while fostering a high-performance culture

Senior Director – US Employer Operations, Head of Medical Call Centers

• Work within the Medical Affairs organization to identify, establish, and manage collaborative professional relationships with community-based scientific leaders (SLs) and healthcare providers.
• Conduct peer-level scientific discussions and maintain a reliable presence to ensure SLs have a Medical Affairs contact within our company.
• Engage in proactive non-product discussions regarding scientific issues to understand real-world prevention gaps, persistent disparities, and barriers to uptake across various care settings.
• Facilitate appropriate scientific exchange of information with SLs, including integration of scientific knowledge with actionable insights to inform our Company's research, development and strategies.
• Communicate external stakeholder opinions, insights, and feedback on new data, clinical trends, and the evolving HIV treatment and prevention landscape to Medical Affairs HQ teams.
• Represent R&D at scientific meetings and congresses to understand the sentiment of the consumer and contribute to R&D debriefs, insight discussions, and post-congress reports.
• Develop and execute territory plans in alignment with global Virology strategy.
• Support data generation activities when requested by R&D leadership, including our company's Investigator Study Program (MISP).
• Identify potential investigators for participation in phase II-IV clinical development programs and provide scientific support for R&D sponsored trials as needed.
• Demonstrate and maintain in-depth knowledge of the assigned disease and therapeutic area(s) through educational efforts.
• Fully comply with all company policies and applicable laws, regulations, and ethical standards.

Community MSL, Virology (HIV) – Regional Medical Scientific Associate Director

• 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

• Lead the company’s clinical affairs initiatives
• Manage all aspects of clinical studies
• Coordinate clinical study workflows and performance evaluations
• Develop and maintain understanding of industry standards and regulations

Director of Clinical Affairs

• Provide leadership, strategic direction, and management of an MSL team to support the company’s mission of advancing precision medicine
• Ensure the team is adequately staffed, trained and clear on the expectations of their role in the execution of their medical plan
• Develop and execute strategies to engage with key opinion leaders (KOLs), healthcare professionals, and other stakeholders within their area
• Lead, mentor, and manage a team of MSLs to ensure effective communication and collaboration with healthcare professionals and KOLs
• Develop and implement strategic plans to support the dissemination of scientific information and data related to Tempus’ products and services
• Establish and maintain relationships with KOLs, healthcare professionals, and other stakeholders to support clinical and scientific objectives
• Oversee the development and delivery of scientific presentations, publications, and other educational materials
• Collaborate with cross-functional teams, including clinical development, marketing, and sales, to support product launches and other initiatives
• Monitor and analyze industry trends, competitive intelligence, and scientific advancements to inform strategic planning
• Ensure compliance with all regulatory and legal requirements in the dissemination of scientific information
• Represent Tempus at scientific conferences, meetings, and other events

Associate Director, Medical Science Liaison

• Manage a professional clinical team responsible for consulting with internal partners, clients, and brokers to identify opportunities where Sun Life Health Care Capabilities can support members, improve access to care, and help clients achieve better financial and health outcomes.
• Lead the team in identifying members and client populations that may benefit from Sun Life Health Care Capabilities, including Clinical 360, Clinical 360+, care navigation, specialty care support, and other solutions that optimize health and reduce avoidable costs.
• Monitor Quality Assurance (QA) reviews regularly and provides staff coaching related to quality measures and feedback.
• Sets performance goals to drive individual performance; reviews staff through the use of performance review tools and provides regular coaching and performance, growth and developmental feedback.
• Provides career development and training opportunities.
• Makes decisions on personnel actions such as hiring, terminations, promotions, salary increases.
• Supports individuals in the identification and implementation of innovative solutions or efficiencies.
• Creates collaborative relationships across Distribution, Client Services, Product, Claims, Operations, vendor partners, and other Health and Risk Solutions teams to support a coordinated service model for clients and brokers.
• Serves as a leading contributor to special projects, operational readiness, and change management activities that advance Sun Life’s health capabilities strategy, improve broker and client engagement, and support measurable outcomes.
• Understands client, broker, member, and business needs and fosters an interdisciplinary clinical operating model that connects clinical expertise, relationship management, and health capability execution.
• Develops and reinforces servicing approaches that clarify roles, improve response consistency, and strengthen broker and client confidence in Sun Life’s ability to deliver health-focused value.
• Maintains operating expenses within budget.
• Ensures Key Performance Indicators are met.
• Other duties as assigned.

Associate Director, Clinical Services

• 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

• Under general supervision of Leadership and in collaboration with the administration team, the Medical Director develops, implements, and evaluates the medical practice delivery model in accordance with the goals of the System’s comprehensive treatment programs
• Assures delivery of quality services to all patients and provides clinical consultation to Leadership
• Participates in the recruitment and selection process for medical providers
• Performs clinical supervision of medical staff, including regular performance appraisals and feedback to staff
• Provides supervision of clinical scheduling, call and leave for medical staff
• Ensures integration of medical services into the System’s overall comprehensive services
• Facilitates medical staff/provider meetings
• Performs or delegates responsibility for quarterly medical record reviews for all medical staff focusing on quality of care and documentation
• Reviews input from medical staff on their ideas and concerns with Leadership or programs

• 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

• Assist the Chief Medical Director to direct and coordinate the medical management, quality improvement and credentialing functions for the business unit
• Provides medical leadership of all for utilization management, cost containment, and medical quality improvement activities
• Performs medical review activities pertaining to utilization review, quality assurance, and medical review of complex, controversial, or experimental medical services, ensuring timely and quality decision making
• Supports effective implementation of performance improvement initiatives for capitated providers
• Assists Chief Medical Director in planning and establishing goals and policies to improve quality and cost-effectiveness of care and service for members
• Provides medical expertise in the operation of approved quality improvement and utilization management programs in accordance with regulatory, state, corporate, and accreditation requirements
• Assists the Chief Medical Director in the functioning of the physician committees including committee structure, processes, and membership
• Conduct regular rounds to assess and coordinate care for high-risk patients, collaborating with care management teams to optimize outcomes
• Collaborates effectively with clinical teams, network providers, appeals team, medical and pharmacy consultants for reviewing complex cases and medical necessity appeals
• Participates in provider network development and new market expansion as appropriate
• Assists in the development and implementation of physician education with respect to clinical issues and policies
• Identifies utilization review studies and evaluates adverse trends in utilization of medical services, unusual provider practice patterns, and adequacy of benefit/payment components
• Identifies clinical quality improvement studies to assist in reducing unwarranted variation in clinical practice in order to improve the quality and cost of care
• Interfaces with physicians and other providers in order to facilitate implementation of recommendations to providers that would improve utilization and health care quality
• Reviews claims involving complex, controversial, or unusual or new services in order to determine medical necessity and appropriate payment
• Develops alliances with the provider community through the development and implementation of the medical management programs
• May represent the business unit before various publics both locally and nationally on medical philosophy, policies, and related issues
• Represents the business unit at appropriate state committees and other ad hoc committees
• May be required to work weekends and holidays in support of business operations, as needed

Medical Director jobs in Montana

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Global Clinical Program Strategy Director

Director, Rx Clinical Operations

Medical Director – Clinical Ops Case Review

Senior Director – US Employer Operations, Head of Medical Call Centers

Community MSL, Virology (HIV) – Regional Medical Scientific Associate Director

Senior Director, Healthcare Product Manager

Director of Clinical Affairs

Associate Director, Medical Science Liaison

Associate Director, Clinical Services

Vice President, Medical Director of Clinical Programs

Medical Director

Senior Medical Director

Medical Director