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

• Drive Quality Medicine & Patient Safety
• Ensure consistent delivery of high-quality, evidence-based care across hospitals
• Coach and develop Medical Directors through record reviews, hospital visits, and real-time feedback
• Champion patient safety initiatives, including event reporting and continuous improvement efforts
• Support adoption of new medical advancements, standards of care, and clinical best practices
• Partner with teams to improve client communication, case management, and follow-up care
• Oversee medical record quality, equipment standards, and clinical compliance
• Manage medical-related client concerns and board complaints through resolution
• Foster a culture of collaboration, accountability, and psychological safety
• Partner with Field Leadership, Medical Affairs, and operations to align priorities and execution
• Support recruiting, hiring, and onboarding of veterinarians, including new graduates
• Proactively identify and address medical, staffing, and operational challenges
• Serve as the medical voice within the field leadership team
• Mentor and grow Medical Directors and veterinarians through coaching and development planning
• Support onboarding, training, and integration of new doctors
• Guide teams on improving efficiency, productivity, and team-based care delivery
• Create an environment that supports continuous learning and career growth

Group Medical Director

• Supports clinicians to ensure timely and consistent responses to members and providers
• Provides guidance for clinical operational aspects of a program
• Serves as a resource and consultant to other areas of the company
• May be required to represent the company to external entities and/or serve on internal and/or external committees
• May chair company committees
• Interprets medical policies and clinical guidelines
• May develop and propose new medical policies based on changes in healthcare
• Leads, develops, directs, and implements clinical and non-clinical activities that impact health care quality cost and outcomes
• Identifies and develops opportunities for innovation to increase effectiveness and quality

Medical Director – Medicare Fee for Service

• Develops ongoing professional relationships with key decision makers in organized health systems to ensure access to medical and scientific information on the full oncology product portfolio and areas of therapeutic interest
• Develops strategic account plans in partnership with the Integrated Account Management (IAM) Account Executive teams and executes medical activities in alignment with agreed plan
• Serves as the primary resource for market dynamics within the territory to understand decision makers’ evolving information needs to feed into the ongoing value-proposition development process for oncology product and non-product offerings
• Effectively communicates and coordinates with Regional Medical Scientific Director regarding medical and scientific support needs in key health systems accounts
• Serves as a resource for the HSO MAD Team Lead, HSO Executive Director Medical Affairs, and other members of Country Medical Affairs on other relevant strategic planning
• Attends and supports scientific and medical meetings and prepares post-meeting deliverables

Health Systems Oncology Medical Affairs Director

• Provide clinical leadership for utilization management programs
• Set UM strategy aligned with organizational goals
• Serve as senior clinical advisor to executive leadership on utilization trends
• Oversee the medical policy team
• Lead the Medical Policy and Utilization Management Governance Committees
• Oversee complex and high-risk utilization review cases
• Conduct clinical reviews and peer-to-peer reviews
• Ensure consistent, evidence-based application of clinical guidelines
• Provide clinical expertise to teams conducting coding and payment integrity
• Act as senior clinical UM liaison to network providers
• Build and maintain strong physician relationships
• Lead development and implementation of UM interventions
• Review utilization data for improvement opportunities
• Ensure UM programs meet regulatory requirements
• Conduct and support training of medical directors and UM staff

Senior Medical Director

• Leverage your background in Pain Medicine disciplines to deliver evidence-based medical reviews that support high-quality patient care.
• Collaborate with healthcare providers and stay current on healthcare regulations and industry developments as you review a wide range of cases.
• Start training remotely in a structured environment with support from trainers, mentors, and leadership to set you up for success.
• Complete time-sensitive, specialized evidence-based medical case reviews for medical necessity on EviCore’s case management software.
• Conduct physician consultation (peer-to-peer) calls with referring providers to discuss evidence–based medical necessity and appropriateness of the requested service or treatment.
• Leverage your clinical expertise to recommend alternative services or treatments as necessary.
• Work collaboratively with over 500 EviCore physician colleagues to help ensure patients receive proper care via evidence-based decision making.

Medical Director – Pain Medicine

• Provides strategic clinical oversight and support of the day-to-day clinical community operations to Executive Directors, Health and Wellness Directors and clinical associates, as well as district and regional team leaders above assigned communities
• Supports the company goals and strategies and optimizes resources to ensure quality care and service delivery, training and development of staff, and management of risk and regulatory compliance
• Responsible for the successful implementation and maintenance of community support center clinical policies and procedures
• Conducts regular clinical quality audits through community site visits and audits of all health care areas to ensure compliance with Brookdale standards and state regulations
• Analyzes specific community models to support staffing of clinical positions based on community size and residents receiving services
• Supports the implementation of quality care and services, and encourages the development of medical professional relationships within the community
• Monitors compliance and assists communities in root cause and corrective action of community quality metrics and clinical outcomes related to falls, elopements, medication administration and reduction of psychotropic drugs as well as skin integrity
• Reviews resident clinical assessments to validate accuracy of resident’s physical, emotional and mental functioning, and validates that clinical services provided to residents are documented in appropriate system/record

District Director – Clinical Services

• 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

• 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

Clinical Director – Training & Quality

• Serve as a subject matter expert and team leader for programs/indications supporting our gene therapy portfolio.
• Lead efforts to bridge clinical science and commercial efforts by ensuring strategic alignment across various internal and external functions.
• Focus on peer-to-peer interactions, the development and execution of advisory boards, KOL advocacy, congress presence, and medical symposia.
• Provide structured feedback to internal teams relative to actionable field insights and advance data generation efforts.
• Develop and execute Medical Affairs strategy across sickle cell disease (SCD) and transfusion dependent thalassemia (TDT).
• Build external relationships to provide scientific and clinical information on therapies to key HCP and bring actionable insights from KOL and treating physicians.
• Engage with industry experts to garner support for scientific messages, clinical research, and product value.
• Offer medical expertise and input to cross-functional teams including commercial, clinical, operations, payor, and advocacy.
• Support the creation of evidence-based content that enhances patient-provider communication.
• Maintain compliance with applicable company policies and regulations.

Regional Medical Director, Gene Therapy

• Plan and execute medical strategy and engagement for assigned customers within Texas
• Maintain knowledge of relevant TA and Pfizer medicines
• Serve as a resource for medical information and customer insights
• Understand Pfizer Medical Affairs priorities
• Deliver approved medical content about Pfizer medicines in malignant hematology
• Identify and seek engagement from priority customer segments
• Provide accurate information in response to medical requests from HCPs
• Collaborate with Global Medical Affairs colleagues for clinical trials
• Cultivate research expertise and familiarity with congress data

Hematology Field Medical Director – non-MD

• 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

• drive strategy and ensure clinical excellence in clinical programs, Stars, risk adjustment and total cost of care
• strengthen partnerships with providers and health systems in the Market
• work closely with Independent Physician Associations (IPA), health systems, aligned managed service organizations (MSO) and independent practices

Market Medical Director

• Medical Director will complete assigned medication utilization reviews (PA) and/or medical necessity appeals for commercial clients; governmental (Medicare/Medicaid) programs and individual client requested coverage determinations or appeals when appropriate
• Makes clinical determinations in accordance with medical necessity and criteria
• Performs scientific literature evaluation using primary, secondary, and tertiary drug resources to support decision-making and recommendations to requesting prescribers
• Follow all internal procedures, job aids, and HIPPA guidelines to protect patient privacy and data security
• Support the Department’s responsibilities to provide peer-to-peer phone call support to physicians/prescribers who call the company with specific and general questions about our clinical programs, communications and utilization review decisions
• Communicates effectively and confidently with members to promote positive health outcomes
• Actively participates in the development of utilization management (PA) criteria and clinical policy revisions/reviews
• Ability to work in a fast-paced environment with shifting priorities
• Weekend on-call responsibilities (shared rotating call)
• Attention to detail and commitment to delivering high-quality work

Medical Director – Texas Licensed

• Develop and manage the Clinical Policy, Regulatory, and Compliance functions within the Office of Clinical Affairs.
• Ensure clinical operations meet healthcare laws and standards.
• Develop and maintain regulatory policies.
• Manage compliance risks and guide policy-related submissions.
• Advise senior leadership and work closely with teams across the organization.

Medical Director, Clinical Regulatory Affairs

• Lead clinical engagement in assigned market, partnering with the Executive Director to drive performance improvement in value-based care within each Aledade partner practice.
• Leverage KPI metrics to identify opportunities for performance improvement of outlier data points within the market they support and partner with the field team to ensure healthcare teams complete worklist entries each week according to goal.
• Conduct clinical engagement calls to foster relationships with physicians and staff, identify and disseminate best practices, dig into clinical workflows, troubleshoot challenging individual patients and brainstorm solutions.
• Provide coaching, skill building and mentorship to Aledade primary care practices to optimize management of patients in their care.
• Engage and motivate physicians and practices to achieve meaningful quality improvements and reduce health care utilization.
• Participate in ACO Board Meetings; lead conversations in the clinical space.
• Coach and mentor Local Medical Directors to expand influence, meet regularly with each Local Medical Director in your region to troubleshoot practice problems and issues and provide strategic direction and support.
• In partnership with field leaders, promote value-based clinical strategy by supporting Aledade products and lending clinical perspective to strategy discussions, including selection and prioritization of Aledade-wide initiatives.
• Assess areas of greatest opportunity with ACO practices and identify areas for potential changes, enhancements, or new programs.
• Collaborate with field, tech, and product teams to optimize initiatives and drive improvements across the ACOs.
• Collaborate across Aledade’s network of Medical Directors to share achievements and seek counsel.**In partnership with field leaders, assist with regional recruitment of top practices for ACO expansion.

Regional Medical Director

• 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

• Medically manages clinical trials to which they are assigned as MM
• Serves as Global Lead MM (GLMM) for pan-regional and/or global trials to which they are assigned
• Collaborates with other members of the Medical & Safety project team to process Serious Adverse Events (SAEs)
• Provides therapeutic and protocol-specific training to the project teams
• Contributes medical input into the design of clinical development programs, study protocols, research papers, client-focused white papers, etc.
• Provides after-hours medical support for projects to which they are assigned
• Independently supports Business Development through participation in proposal generation, feasibility assessments, review of proposals/contracts for medical services, and attendance at meetings with sponsors as directed by department senior management
• Reviews and/or assists in the preparation of final study reports (CSRs) or other study documentation (protocols, ISS/ISEs, etc.) as directed by senior management
• Maintains a high level of competence with assigned projects, including knowledge of project and therapeutic advances as well as marketplace developments by participating in internal meetings (company-wide project tracking, medical management meetings, etc.), reviewing relevant therapeutic/clinical literature, and attending conferences and meetings
• Interacts with staff in other functional areas within the company to ensure the highest level of client satisfaction through the successful execution of projects
• Identifies, documents, and appropriately resolves out-of-scope work as directed by senior management
• Assists in the annual attainment of departmental revenue targets and any other activities as directed by senior management
• Maintains working knowledge of Good Clinical Practices (GCPs) and regulatory requirements relating to clinical development and safety to assure compliance with ethical, legal, and regulatory standards
• Mentors other medical staff as directed by senior management and, by consistently displaying exemplary work ethics, compassion, and integrity, supports senior management’s leadership of both the department and the company
• Maintains clinical/therapeutic acumen in medical subspecialty through online and/or in-person scholarly programs/lectures
• Demonstrates competence with the execution of SAE-related medical review in Worldwide Clinical Trials’ electronic safety database
• Perform other duties as assigned.

Senior Medical Director, Medical Affairs

• You’ll start training remotely in a structured environment with support from trainers, mentors, and leadership to set you up for success.
• Complete time-sensitive, specialized evidence-based medical case reviews for medical necessity on EviCore’s case management software.
• Conduct physician consultation (peer-to-peer) calls with referring providers to discuss evidence–based medical necessity and appropriateness of the requested service or treatment.
• Leverage your clinical expertise to recommend alternative services or treatments as necessary.
• Work collaboratively with over 500 EviCore physician colleagues to help ensure patients receive proper care via evidence-based decision making.

Medical Director – Medical Genetics, Genomics

• Provides clear medical leadership in the Study team
• Creates clinical trial protocols while implementing the latest scientific information
• Contributes to site selection
• Reviews and approves study protocols and amendments, Clinical Study Reports (CSRs), Informed Consent Forms (ICFs), Case Report Forms (CRFs), protocol deviation decisions and other clinical documents as required for clinical trials
• Real time Medical Monitoring of clinical studies
• Ensures early identification of medical issues
• Interprets clinical trial data for regulatory documents
• Acts as the medical point of contact for all internal and external stakeholders
• Ensures study compliance for all medical aspects

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