Medical Director

• 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

• Work within the Medical Affairs organization to identify, establish, and manage collaborative professional relationships with community-based scientific leaders (SLs) and healthcare providers.
• Conduct peer-level scientific discussions and maintain a reliable presence to ensure SLs have a Medical Affairs contact within our company.
• Engage in proactive non-product discussions regarding scientific issues to understand real-world prevention gaps, persistent disparities, and barriers to uptake across various care settings.
• Facilitate appropriate scientific exchange of information with SLs, including integration of scientific knowledge with actionable insights to inform our Company's research, development and strategies.
• Communicate external stakeholder opinions, insights, and feedback on new data, clinical trends, and the evolving HIV treatment and prevention landscape to Medical Affairs HQ teams.
• Represent R&D at scientific meetings and congresses to understand the sentiment of the consumer and contribute to R&D debriefs, insight discussions, and post-congress reports.
• Develop and execute territory plans in alignment with global Virology strategy.
• Support data generation activities when requested by R&D leadership, including our company's Investigator Study Program (MISP).
• Identify potential investigators for participation in phase II-IV clinical development programs and provide scientific support for R&D sponsored trials as needed.
• Demonstrate and maintain in-depth knowledge of the assigned disease and therapeutic area(s) through educational efforts.
• Fully comply with all company policies and applicable laws, regulations, and ethical standards.

Community MSL, Virology (HIV) – Regional Medical Scientific Associate Director

• Manage a professional clinical team responsible for consulting with internal partners, clients, and brokers to identify opportunities where Sun Life Health Care Capabilities can support members, improve access to care, and help clients achieve better financial and health outcomes.
• Lead the team in identifying members and client populations that may benefit from Sun Life Health Care Capabilities, including Clinical 360, Clinical 360+, care navigation, specialty care support, and other solutions that optimize health and reduce avoidable costs.
• Monitor Quality Assurance (QA) reviews regularly and provides staff coaching related to quality measures and feedback.
• Sets performance goals to drive individual performance; reviews staff through the use of performance review tools and provides regular coaching and performance, growth and developmental feedback.
• Provides career development and training opportunities.
• Makes decisions on personnel actions such as hiring, terminations, promotions, salary increases.
• Supports individuals in the identification and implementation of innovative solutions or efficiencies.
• Creates collaborative relationships across Distribution, Client Services, Product, Claims, Operations, vendor partners, and other Health and Risk Solutions teams to support a coordinated service model for clients and brokers.
• Serves as a leading contributor to special projects, operational readiness, and change management activities that advance Sun Life’s health capabilities strategy, improve broker and client engagement, and support measurable outcomes.
• Understands client, broker, member, and business needs and fosters an interdisciplinary clinical operating model that connects clinical expertise, relationship management, and health capability execution.
• Develops and reinforces servicing approaches that clarify roles, improve response consistency, and strengthen broker and client confidence in Sun Life’s ability to deliver health-focused value.
• Maintains operating expenses within budget.
• Ensures Key Performance Indicators are met.
• Other duties as assigned.

Associate Director, Clinical Services

• 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 Wisconsin

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Director, Rx Clinical Operations

Medical Director – Clinical Ops Case Review

Community MSL, Virology (HIV) – Regional Medical Scientific Associate Director

Associate Director, Clinical Services

Medical Director – Surgery