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

• Conduct timely medical necessity determinations for inpatient admissions, continued stays, and post-acute care settings for Commercial and Medicare Advantage populations
• Apply nationally recognized guidelines to ensure appropriate level-of-care determinations
• Serve as the lead physician reviewer for complex, high-risk, or potentially adverse UM cases requiring clinical judgment
• Conduct peer-to-peer discussions with attending and treating physicians to clarify documentation, discuss options, and align on appropriate care plans
• Partner with Care Management and UM teams to identify utilization trends, reduce avoidable readmissions/extended stays, and streamline care transitions
• Offer clinical expertise to support quality improvement initiatives, regulatory audit preparedness, policy development, and UM committee activities
• Maintain precise, compliant, and timely documentation of all reviews and rationales in accordance with federal, state, and organizational guidelines.

Medical Director, Utilization Management – Commercial & MA

• Lead and shape the clinical education experience for respiratory therapy students across diverse healthcare settings.
• Oversee the design, coordination, and continuous improvement of clinical learning experiences.
• Organize and manage clinical placements.
• Evaluate program effectiveness, and foster strong partnerships with clinical sites and preceptors.
• Provide oversight and support to part-time faculty delivering instruction in remote locations.
• Actively teach students throughout Nevada using in-person, Zoom, and online platforms.
• Make a meaningful impact on rural healthcare workforce development while working in a flexible, student-centered environment.
• Travel within the GBC service area as required.

Director of Clinical Education – Cardio-Respiratory Care Instructor

• 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

• Align and execute on business strategy – marketing, market access pull-through, launches, multi-channel customer engagement, and employee development, to deliver exceptional results
• Prioritize and customize Regional investments/resources (People and Promotion) in a manner which maximizes top and bottom-line growth of the local market based upon identified opportunities as a result of evolving business environment
• Understand and Integrate Regional healthcare ecosystem trends into business plans (payer – public and private, local economics, health-system & providers – including value and quality, and competition) to maximize success
• Deliver and adapt execution plans to achieve performance goals and objectives utilizing; KPIs, scaling of successes, business problem solving, etc.
• Develop and foster external relationships with key influential customers and thought leaders
• Recruit, hire and develop a high performing team of TAMs
• Build team capability for current and future needs, including attracting, identifying and developing a diverse talent pool
• Create a coaching culture and demonstrate situational leadership to maximize performance and development of each individual and deliver exceptional results for the team
• Set the tone and culture of the team, role model ViiV Expectations and manage change by leading through transitions with inspiration and high engagement
• Implement corrective action as appropriate to meet business needs and improve performance
• Identify and manage risks, while allocating resources and executing on priorities
• Understand Regional (State level) regulatory environment and required changes for execution to stay compliant
• Escalate issues and risks and inform centrally when needed; create a ’speak up’ culture

Regional Sales Director, Rocky Mountains

• Elevating Patient Care: Monitoring doctor interactions and medicine protocols to ensure the highest standards of care.
• Developing Our Teams: Mentoring and coaching staff, fostering a positive and collaborative work environment.
• Resolving Challenges: Assisting in the resolution of staff and/or client conflicts, promoting effective communication and problem-solving.
• Driving Operational Excellence: Collaborating with the leadership team (Regional Directors, Practice Managers, Veterinarians, etc.) to support staff and optimize business operations.
• Ensuring Compliance: Maintaining operational and medical execution consistent with company policies and procedures, including tracking package utilization, responding to client and staff concerns, monitoring discounts, and ensuring compliance.
• Growth & Performance: Taking ownership of preserving transaction rates and pet count, contributing to the overall success of the region.
• Mentorship & Support: Providing guidance and support to new graduate veterinarians, helping them thrive in their careers.

Regional Medical Director

• 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.

Virology Community MSL, Regional Medical Scientific Associate Director

• 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

• Cultivates relationships with decision-makers and influencers within prospective customers
• Serves as a clinical thought leader and develops strategic messaging and partners with Sales RVPs, Account Executives and Account Managers for new sales
• Supports account finalist opportunities and client quarterly and annual reviews
• Ensures high-quality and efficient medical services are provided to accounts
• Serves as the voice of health policy to the clients and consults with and advises them in shaping their decisions around clinical programs and strategy
• Serves as a medical subject matter expert in one of several areas to provide counsel and advice on relevant strategies and initiatives
• May represent the company on external committees or with applicable vendors as needed
• Fosters a culture of continuous improvement and best practice sharing in support of clinical models

Account Management Medical Director – RVP

• Design, implement, and improve education, quality, and accreditation programs
• Develop and manage training curriculum for clinical staff
• Design and deliver palliative care-specific education programs
• Integrate value-based care principles into training frameworks
• Oversee simulation-based training and competency assessments
• Lead the organization's QA/QI program and establish quality metrics
• Analyze clinical and operational data for improvement
• Collaborate with the Compliance Department for regulatory education

Medical Director jobs in Nevada

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