Medical Director – Scientific Affairs

This is a fully remote position, open to applicants in Florida.

📋 Description

• Act as the primary subject matter expert in evidence-based practices, converting clinical research into implementable strategies to enhance care quality throughout the organization.

• Spearhead the research, formulation, revision, and clinical accuracy of all medical, utilization management (UM), and pharmacy coverage policies.

• Provide guidance to executive leadership on emerging medical therapies, intricate clinical trends, and population health utilization patterns utilizing data-driven insights.

• Assist in the creation of clinical and lifestyle products through evidence-based research tailored to specific target populations.

• Cultivate academic partnerships to advance and publish clinical research by leveraging data from health plan populations.

• Conduct systematic reviews of significant specialty society guidelines, including those from ASCO, ACC, and AACE.

• Establish, uphold, and enforce the framework for evaluating clinical evidence.

• Supervise Clinical Advisory Subcommittees by setting agendas, presenting clinical evidence packages, and facilitating expert consensus.

• Collaborate with Pharmacy Services, Legal, and Compliance to integrate coverage policies that align with NCQA standards and state/federal regulations.

• Support engagements with federal and state regulatory entities, including FDA, CMS, and State DOIs.

• Adhere to all relevant laws and regulations.

• Undertake other assigned responsibilities.

⛳️ Requirements

• Over 10 years of experience in relevant fields.

• More than 6 years of clinical policy experience in health insurance, PBM, or other organizations focused on clinical guideline development.

• At least 4 years of experience in drafting and developing clinical policy.

• A minimum of 4 years leading, chairing, or facilitating multi-disciplinary clinical committees or advisory subcommittees.

• At least 4 years of publishing experience in relevant domains.

• Over 3 years of experience in executive communication and collaboration with all organizational levels.

• More than 3 years of leadership experience as a people manager.

• A minimum of 1 year of experience with medical coding terminologies (HCPCs, CPT, ICD-10).

• A Medical Degree (MD or DO) from an accredited institution in medicine or osteopathic medicine is required.

• Current board certification recognized by the American Board of Medical Specialties (ABMS) or the American Osteopathic Association (AOA).

🏝️ Benefits

• Comprehensive employee benefits.

• Unlimited vacation program.

• Company equity grants.

• Annual performance bonuses.

• Medical benefits.

• Dental benefits.

• Vision benefits.

• 11 paid holidays.

• Paid sick time.

• Paid parental leave.

• Participation in a 401(k) plan.

• Life insurance.

• Disability insurance.

• Paid wellness time and reimbursements.