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

• 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

• 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

• Provide oversight and support for psychotherapy clinicians
• Engage through coaching and education of new and tenured clinicians
• Enhance ongoing clinician professional growth and development
• Work in dyad partnership with Practice Group Manager to enhance, plan for, and implement clinical strategy and related operations
• Ensure clinical integrity and compliance through local monitoring and risk management

Clinical Director

• 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

• 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
• Provides medical expertise in the operation of approved quality improvement and utilization management programs
• Assists the Chief Medical Director in the functioning of the physician committees
• 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
• 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
• Identifies clinical quality improvement studies to assist in reducing unwarranted variation in clinical practice
• Interfaces with physicians and other providers in order to facilitate implementation of recommendations to providers
• 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
• May be required to work weekends and holidays in support of business operations, as needed

Medical Director, Appeals

• Lead clinical engagement in assigned market(s), partnering with the Executive Director/Market President/Regional Market President 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(s) 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.

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