Medical Director, Clinical Policy

The Medical Director, Clinical Policy provides clinical leadership and strategic oversight for the development, implementation, governance, and evaluation of clinical policies that guide the organization’s medical and utilization management practices. This position ensures clinical policies and utilization management frameworks are evidence-based, operationally sound, compliant with regulatory and accreditation requirements, and aligned with organizational goals related to quality, safety, affordability, and member experience. The Medical Director oversees policy architecture, authorization strategy, and utilization oversight across all lines of business, ensuring clinical intent is accurately translated into authorization requirements, coding structures, and system configuration through partnership with internal teams. This position works collaboratively across internal departments to support consistent, high-quality, and defensible medical decision-making, effective utilization controls, and appropriate care delivery within a rapidly evolving regulatory environment. Partners with executive leadership, clinical teams, and external stakeholders to improve outcomes, support regulatory compliance, and advance organizational goals.