Medical Director

• 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

• Plan and execute Medical strategy and engagement in assigned territory
• 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 to contribute to strategy development
• Communicate and collaborate with headquarters and other colleagues
• Deliver approved medical content about Pfizer medicines to HCPs
• Provide accurate information in response to unsolicited medical requests
• Collaborate with Oncology Research & Development for clinical trials
• Cultivate research and therapeutic area expertise
• Mentor and participate in special projects as needed

Oncology Field 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
• 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
• Conduct regular rounds to assess and coordinate care for high-risk patients
• 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.
• Reviews claims involving complex, controversial, or unusual or new services in order to determine medical necessity and appropriate payment.

• Perform concurrent and prior authorization reviews with peer to peer coverage of denials.
• Perform appeals in their 'base plans' and may round robin based on 'same or similar specialty' needs.
• Perform pharmacy reviews.
• Participate in and be able to lead rounds.

Medical Director – Duals Center of Excellence

• perform concurrent and prior authorization reviews with peer to peer coverage of denials.
• perform appeals in their 'base plans' and may round robin based on 'same or similar specialty' needs.
• perform pharmacy reviews.
• participate in and be able to lead rounds.

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