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

• Medical Director - National Accounts responsible for serving as the Operational Medical Director
• Supporting clinical vision and implementation to improve health for members
• Involved in utilization review and case management
• Conduct clinical report reviews and trend management

Medical Director – National Accounts

• Serve as a senior clinical leader and addiction medicine subject matter expert across the organization.
• Partner with Clinical Services leadership to strengthen clinical quality, consistency, and patient safety across Boulder’s care delivery model.
• Lead routine review and refinement of clinical protocols, formulary standards, and evidence-based practice guidelines.
• Support quality assurance activities, chart review processes, and clinical audits to identify opportunities for improvement.
• Provide consultation and guidance on complex clinical cases and emerging clinical issues.
• Ensure Boulder’s clinical standards remain aligned with current evidence, regulatory requirements, and payer expectations.
• Partner with Clinical Services leadership to strengthen clinical leadership capabilities across the organization.
• Provide mentorship, coaching, and support to clinical leaders and clinicians navigating complex clinical and operational challenges.
• Help establish and reinforce standards of clinical excellence, professional growth, and evidence-based practice.
• Contribute physician leadership and oversight to clinician education, onboarding standards, and ongoing clinical development programs.
• Support the development of systems that promote accountability, consistency, and continuous improvement across the clinical organization.
• Translate quality findings, operational priorities, and emerging evidence into scalable clinical workflows and care delivery standards.
• Identify gaps in clinical processes, policies, and infrastructure and partner across teams to implement solutions.
• Support implementation of new clinical initiatives and ensure clinical best practices are operationally viable and consistently applied.
• Drive adoption of new clinical workflows, protocols, and care models across a distributed clinical workforce.
• Partner with Medical Affairs and Clinical Services leadership to evaluate and support expansion into new service lines and care models.
• Assess clinical readiness, staffing considerations, protocol requirements, and quality implications for new programs.
• Ensure new services are designed with appropriate clinical governance, quality standards, and outcome measurement strategies.
• Contribute clinical expertise to Boulder’s long-term vision of comprehensive substance use disorder care.
• Serve as a clinical liaison to Product, Operations, Analytics, and other cross-functional teams.
• Translate clinical priorities into product requirements, workflows, and operational processes.
• Provide clinical input on care delivery technology, clinical decision support tools, AI-enabled workflows, and platform enhancements.
• Ensure operational and product changes are evaluated through the lens of patient safety, clinician experience, clinical effectiveness, and quality.

Medical Director – Addiction Medicine, Telehealth

• 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

• Works with and supports interdepartmental and facility teams companywide
• Reviews and evaluates complex applications/forms/requests of healthcare regulatory licensure and Medicare enrollment documentation
• Processes and monitors applications for ASCs, hospitals, and practices
• Communicates with ASC, hospital and practice teams and external authorities regarding licensure and healthcare regulatory matters
• Maintains accurate and current files and databases
• Supports and maintains healthcare regulatory licensure processes and Medicare enrollments
• Supports problem resolution related to licensure matters and Medicare enrollments
• Analyzes and compiles ownership and management disclosure information
• Creates and maintains ASC, hospital, and practice ownership charts
• Supports due diligence processes for proposed transactions
• Develops and maintains professional relationships with various healthcare regulatory authorities
• Collaborates as part of a team on healthcare regulatory related duties

Licensure & Healthcare Regulatory Director

• 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

• Oversees the Psychiatric Medical Care (PMC) Compliance Program
• Leads PMC's Corporate Compliance Program and Committee
• Develops, initiates, and maintains policies and procedures
• Collaborates with departments on compliance issues
• Consults with HR, Clinical, and Operations as needed
• Responds to alleged violations and develops handling systems
• Identifies compliance vulnerabilities and develops corrective actions
• Monitors reporting of violations to authorized agencies
• Institutes compliance communication programs
• Develops compliance training programs
• Prepares reports to the Board of Directors and CEO

Corporate Healthcare Compliance Director

• Responsible for clinical quality and or administrative activities in Ambulatory Surgery Centers
• Evaluating compliance with local and federal regulations
• Monitoring quality and patient experience data
• Engaging with center clinical and medical staff
• Ensure employee files are complete and staff training is up to date
• Provide exceptional customer service
• Submit weekly reports to Sr. Director of Clinical Operations

Director, Clinical Services – PRN

• Responsible for clinical quality and administrative activities in Ambulatory Surgery Centers (ASC)
• Execute quality and safety plans and center policies
• Evaluate compliance with applicable CMS and State regulations
• Monitor clinical activities and overall administrative functions
• Develop and monitor center action plans

Director, Clinical Services

• Supports operations in the form of case review on both medical and regulatory matters.
• Develops claim adjudication criteria for situations requiring medical judgment.
• Provides input on issues and operational policies, processes, and procedures.
• Educates staff and medical community on various aspects of medical policy and program administration.
• May develop and update medical policy in consultation with appropriate regulatory personnel, medical consultants, and professional societies.
• Develops external relationships with the medical community and serves as liaison between these entities and the contractors.
• Reviews physician and provider practice pattern analysis and other statistical data related to unusual medical service utilization.
• Conducts research into new or controversial medical procedures and technology.

Chief Medical Officer – Medicare Policy

• Provides administrative oversight to the medical staff
• Analyzes medical review utilization data
• Researches new medical procedures or technology
• Acts as a lead resource to providers and internal staff on issues concerning medical policies
• Heavily involved in policy generation, includes the development of new policy and revision of old policy
• Supports operations in the form of case review on both medical and regulatory matters
• Develops claim adjudication criteria for situations requiring medical judgment
• Educates staff and medical community on various aspects of medical policy and program administration
• Develops and updates medical policy in consultation with regulatory personnel, medical consultants, and professional societies
• Develops external relationships with the medical community and serves as liaison between these entities and the contractors
• Reviews physician and provider practice pattern analysis and other statistical data related to unusual medical service utilization
• Conducts research into new or controversial medical procedures and technology

• 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)
• The MPE will collaborate with Monogram Health’s Multi-Specialty Platform to leverage employed specialists to deliver in-home specialty care
• Monogram Health deploys a proven risk-based model to ensure health equity and health equality leveraging proprietary next generation AI algorithms to predict the appropriate level of care
• Aligning with the quadruple AIM, the MPE will focus to improve patient experience, population health outcomes, provider satisfaction and lower costs
• 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
• Overall accountability for reducing total cost of care and Medical Loss Ratio
• Responsible for clinical outcomes to include, but not limited to, clinical interventions closure, inpatient/outpatient utilization, pharmacological prescribing and therapy management, multi-specialty platform and HEDIS/Gap Closure
• Actively lead daily high risk and concurrent review rounds
• Direct supervision of front line clinical and operations team members
• Oversee and delegate operational responsibility to Market Manager
• Regularly assess and present market performance and outcomes to Executive and Senior Leaders

Market Physician Executive – Float

• Determines the medical necessity of requests using clinical criteria
• Performs physician-level case review of surgical utilization requests
• Conducts peer-to-peer consultation with ordering physicians, physician assistants and advanced practice nurses regarding established guidelines and accepted standards of care as it relates to treatments, procedures, imaging and appropriate sites of service
• Provides education regarding applicable clinical criteria and discusses clinically appropriate interventional and non-interventional options
• Performs first level provider appeals for coverage decisions
• Provides support and education to internal clinical and non-clinical staff regarding the principles associated with appropriate diagnoses, treatments, and management of conditions and surgical procedures
• Participates in physician team meetings
• Participates in groups that develop, revise and enhance clinical appropriateness guidelines

Medical Director jobs in Tennessee

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Director of Ancillary, Clinical Systems

Medical Director – National Accounts

Medical Director – Addiction Medicine, Telehealth

Director, Rx Clinical Operations

Medical Director – Clinical Ops Case Review

Licensure & Healthcare Regulatory Director

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

Corporate Healthcare Compliance Director

Director, Clinical Services – PRN

Director, Clinical Services

Chief Medical Officer – Medicare Policy

Chief Medical Officer – Medicare Policy

Market Physician Executive – Float

Medical Director – Surgery