Medical Director

• Responsible for assisting the Medical Director in the oversight of Utilization Management (UM) programs
• Support the development and maintenance of these programs, focusing on clinical accuracy and appropriateness
• Assist the Medical Director in developing strategic corporate direction for UM programs
• Support the SVP, Healthcare Services in preparing annual metrics of results for UM programs
• Contribute to measurable outcomes for prior authorization, step therapy, and quantity limit programs
• Collaborate with internal teams to support corporate HEDIS initiatives with appropriate clinical program development
• Work closely with clinical program development teams, clinical service operations, and clinical quality committees
• Provide clinical guidance and oversight to these areas
• Serve on IH committees as directed by the Medical Director

Associate Medical Director – UM PT

• 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

• 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.

• Bring knowledge and skills to the business of Blue Cross North Carolina
• Support value-based strategies and clinical operations
• Develop and drive strategy for varied Health Care initiatives
• Partner with internal and external clients to support agreements
• Evaluate and manage vendors to align with strategic direction
• Gather and analyze data for health outcomes improvement
• Represent BCNC through presentations and leadership

Associate Medical Director

• Market Physician Executive (MPE) are mission driven physician leaders who are dedicated to improving the well-being, quality of life, and health outcomes for our patients.
• The MPE will lead our in-home multi-specialty polychronic care model in an assigned market.
• Collaborate with Monogram Health’s Multi-Specialty Platform to leverage employed specialists to deliver in-home specialty care.
• Reporting to the Region President, the MPE is a key clinical leader within Monogram Health who contributes to the development and oversight of clinical strategies, policies, programs, processes, protocols, guidelines, and operations that drive improved patient health outcomes within the market.
• Oversee the daily clinical and business operations through delivery of direct patient care, care management services, social worker support and pharmacy services within the market.
• Actively lead daily high risk and concurrent review rounds.
• Direct supervision of front line clinical and operations team members.
• Provide direct and indirect patient care (including diagnosis and treatment of disease).

Market Physician Executive – MPE

• Monogram Market Physician Executive (MPE) are mission driven physician leaders who are dedicated to improving the well-being, quality of life, and health outcomes for our patients.
• The MPE will lead our in-home multi-specialty polychronic care model in an assigned market.
• Each market is comprised of 5-10 practices led by local advanced practice providers (APP), registered nurses(RN), licensed clinical social workers (LCSW), and pharmacists (PharmD).
• Collaborate with Monogram Health’s Multi-Specialty Platform to leverage employed specialists to deliver in-home specialty care.
• The primary goal of each MPE to deliver exceptional outcomes through disease detection and evidence based clinical pathways and disease treatment.
• Reporting to the Region President, the Market Physician Executive (MPE) is a key clinical leader within Monogram Health who contributes to the development and oversight of clinical strategies, policies, programs, processes, protocols, guidelines, and operations that drive improved patient health outcomes within the market.
• The MPE oversees the daily clinical and business operations through delivery of direct patient care, care management services, social worker support and pharmacy services within the market.
• In support of the advance practice providers the MPE is expected to review and approve care plans and direct the treatment plans for our patients.
• The MPE will collaborate with community physicians, facilities, and partners in peer to peer and direct patient care decision making.

Market Physician Executive

• Serve as the clinical authority for clinical data definitions and decision logic frameworks
• Build team capability in clinical data science and outcomes measurement
• Serve as the clinical informatics subject matter expert for product teams
• Review and approve clinical-facing content and logic for accuracy
• Partner with Data/Analytics and Data Science teams to define analytical approaches

Senior Medical Director – Clinical Informatics

• 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

• 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

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Associate Medical Director – UM PT

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Market Physician Executive

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Oncology Field Medical Director – MD

Oncology Field Medical Director – Non-MD