Medical Director

• Lead execution of prioritized account strategies through coaching, inspection, and development of a team of Associate Directors, ensuring focused action against implementation barriers and measurable customer outcomes.
• Partner with key customer stakeholders to accelerate implementation readiness, optimize operational processes, and support sustainable adoption of long-acting injectable therapies.
• Prioritize and customize regional investments/resources (People and Implementation Solutions) in a manner which optimizes post prescribing growth of the local market based upon identified opportunities as a result of evolving business environment.
• Establish and lead cohesive and comprehensive Patient Access and Affordability Strategy based on key coverage, coding, payment, product acquisition and affordability dynamics for ViiV Healthcare products in assigned geography and provide leadership support for case escalations to deliver an exceptional implementation experience.

Field Reimbursement Director, Central Region

• 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

• 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

• Expand Assured Imaging Capital’s market presence through new business acquisition.
• Maintain a strong in-market presence through regular in-person meetings and site visits.
• Build long-term relationships with executive, clinical, and operational stakeholders.
• Manage the full sales cycle from prospecting through contract execution.
• Collaborate with cross-functional teams to design and present tailored imaging solutions.
• Track all sales and business development activity in Salesforce and report on pipeline progress.

Director of Sales – Mobile Medical Coaches, Imaging Equipment

• 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

• Provides leadership of medical management activities in Aetna’s Northeast region (Maryland, New Jersey, New York, Pennsylvania, and Virginia)
• Lead a team of Medical Directors
• Collaborate with health plan chief medical officers
• Implement medical management programs/policies
• Direct the utilization review process and oversee the quality of utilization determinations

Senior Medical Director – Medicaid

• Providing consultation and appropriate mortality assessment of complex medical files
• Interpreting laboratory and medical test results used to detect, diagnose, or monitor diseases that are seen in underwriting risk assessment
• Participating in the continuing education of the JH underwriting team
• Supporting research and development of manual updates with evidence-based research if needed

Medical Director jobs in Oklahoma

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