Medical Director for Clinical Policy Job at Royal College of General Practitioners

Medical Director, Clinical Policy

The Medical Director, Clinical Policy provides clinical leadership and strategic...

Location

United States , Los Angeles

Salary:

206311.00 - 350729.00 USD / Year

L.A. Care Health Plan

Expiration Date

Until further notice

Requirements

Doctor of Medicine (M.D.)
At least 8 years of experience in managed care, clinical policy development, or utilization management leadership
Extensive post-medical degree experience in clinical practice
Significant experience in a clinical development, medical affairs, or management role within the biotech, pharmaceutical, or healthcare industry
Proven experience in a physician leadership role, including managing teams
Board Certified, preferably in a primary or medical specialty - Active, current and unrestricted California license
Current clinical license to practice or an administrative license to review Utilization Management (UM) cases

Job Responsibility

Provide executive clinical leadership in the development, review, approval, and ongoing oversight of clinical policies and coverage criteria
Ensure all clinical policies comply with applicable federal, state, and accreditation requirements
Monitor emerging medical technologies, procedures, evidence-based practices, and external benchmarks
Provide strategic oversight of benefit design and clinical architecture
Validate codes, rules, and clinical logic are appropriately aligned and consistently applied
Oversee authorization matrix strategy and governance
Provide clinical direction for prior authorization requirements
Oversee the Clinical Criteria Hierarchy
Guide the strategic development of pre-payment review approaches
Oversee service-level utilization tracking and analysis

What we offer

Paid Time Off (PTO)
Tuition Reimbursement
Retirement Plans
Medical, Dental and Vision
Wellness Program
Volunteer Time Off (VTO)

Fulltime

Medical Director/Sr Medical Director - Neurology

Join Us as a Medical Director – Make an Impact at the Forefront of Innovation. A...

Location

United States

Salary:

Not provided

myGwork - LGBTQ+ Business Community

Expiration Date

Until further notice

Requirements

MD or equivalent required
Active medical licensure preferred
Clinical experience in treating patients in the specialty or sub-specialty associated with the applicants training (comparable to 2 years), i.e. Neurology Residency/Fellowship
Suitable clinical trial experience in a Contract Research Organization, pharmaceutical company or as a principal investigator (comparable to 1-2 years) in the industry
Direct experience in safety/Pharmacovigilance (comparable to 2 years)
Therapeutic expertise across one or more medical specialty or sub-specialties
Strong decision-making, problem solving, organizational skills and analytical skills
Excellent oral and written communication skills
Working knowledge of relevant safety databases (e.g. Medra)
Flexibility to travel domestically and internationally

Job Responsibility

Manage all medical aspects of contracted tasks across the pharmaceutical product life-cycle
Ensure tasks delegated to PV are properly executed
Adhere to applicable regulations and ICH guidelines regarding clinical trials, regulatory documents, and safety issues
Follow client SOPs/directives and project-specific WPDs for assigned projects
Comply with CRG’s corporate policies and SOPs/WPDs
Provide medical consultation to team members and answer all study-related medical questions
Communicate clearly with associates and clients, maintaining an open line of communication to ensure all procedures are followed appropriately
Provide therapeutic training and protocol training on assigned studies, as requested
Assist in writing (interpretation of safety and efficacy data) and/or reviewing CSR, IND/NDA reports, ICSR, signal detection reports, periodic reports, RMP, REMS, CTD modules, etc., to ensure that the medical content is accurate and complete
Monitor all safety variables (AE, laboratory abnormalities, changes in patient medical status, evaluation of prescribed concomitant medication for protocol restrictions, and un-blinding requests) of clinical studies

Fulltime

Vice President, Medical Affairs, Asia & Country Medical Director, Singapore

Moderna is seeking a Vice President of Medical Affairs to lead our overarching s...

Location

Singapore , Singapore

Salary:

Not provided

Moderna

Expiration Date

Until further notice

Requirements

M.D. or equivalent degree from a recognized Medical School (advanced degree and a current license to practice are a plus)
Minimum 15 years of experience in the global pharmaceutical industry in Clinical Development and/or Medical Affairs with a demonstrated successful track record
Experience in vaccine clinical development and medical affairs
Proven leadership skills, including the ability to train and develop talent and create a high-performing team
Strong prioritization, decision-making, and organizational skills
Proven expertise in engaging with scientific leaders and other key stakeholders, preferably in the field of Vaccines
Excellent oral and written communication skills
Ability to lead and collaborate in cross-functional teams in a matrix environment
Knowledge of clinical trial methodology, regulatory requirements, and the compliance environment
Proficiency in English (verbal and/or written) required due to global collaboration needs

Job Responsibility

Design and champion the overarching Medical Affairs plan for infectious diseases across the Asia markets
Build and lead medical teams across the region
Engage with external stakeholders, including healthcare authorities, payers, and scientific communities
Orchestrate comprehensive regional insight and scientific leadership activities to support clinical development and the adoption of innovative vaccination approaches
Shape the external environment in conjunction with policy
Create a roadmap for establishing future local and country medical teams in Asia
Drive the medical innovation agenda
Strategically steer Singapore's Medical Affairs strategy and operations
Develop and maintain strategic relationships with local healthcare practitioners, regulatory authorities, and health institutions
Lead the strategic direction of medical affairs contributions to reimbursement submissions, procurement agreements, and tenders specific to Singapore

What we offer

Best-in-class healthcare, plus voluntary benefit programs
A holistic approach to well-being with access to fitness, mindfulness, and mental health support
Family building benefits, including fertility, adoption, and surrogacy support
Generous paid time off, including vacation, bank holidays, volunteer days, sabbatical, global recharge days, and a discretionary year-end shutdown
Savings and investments to help you plan for the future
Location-specific perks and extras

Fulltime

New

Medical Director, Behavioral Health - SIU

We're building a world of health around every individual — shaping a more connec...

Location

United States , Work at Home

Salary:

174070.00 - 374920.00 USD / Year

CVS Health

Expiration Date

June 26, 2026

Requirements

Five (5) or more years of experience in a healthcare delivery system (e.g., clinical practice)
Board Certified Psychiatrist not 'Board Eligible' - Active and Unencumbered license to practice medicine
Knowledge of pertinent policies and procedures related to claims payment of healthcare related services
Active and current state medical license(s) without encumbrances - M.D. or D.O., Board Certification in psychiatry, including 5 years of post-graduate direct patient care experience

Job Responsibility

Performing reviews of BH medical records and/or CPT code/HCPCS codes of known or suspected acts of healthcare fraud and abuse
Serves as a clinical liaison supporting SIU Investigators, Managers, and Directors as appropriate in matters pertaining to the investigation of suspected healthcare fraud cases
Provides clinical expertise and consultation in the creation of data analytic monitors to identify potential patterns of suspected fraud, waste or abuse
Provides consultation to staff regarding root cause analysis and identification of control gaps in Policies, Procedures, Claims edits etc., and assists in seeking appropriate departments to identify solutions
Provides clinical expertise to internal and customers regarding healthcare fraud matters and Aetna's approach to fighting fraud
Maintains open communication with constituents within the company
Uses available resources and technology in developing evidence, supporting allegations of fraud and abuse
Researches and prepares cases for clinical and legal review
Documents all appropriate information related to medical record review determinations
Represents Aetna as a witness in court actions, as required, and as approved by Legal

What we offer

Medical, dental, and vision coverage
Paid time off
Retirement savings options
Wellness programs
CVS Health bonus, commission or short-term incentive program
Equity award program award target

Fulltime