Medical Director Therapy Jobs

Overview: Guidepoint Insight is seeking an Equity Analyst to support the expansion of our research coverage of China biotech, medtech and healthcare services companies. This role plays a critical part in building and scaling the Guidepoint Library, a central resource offering transcript-based insights through teleconferences with KOLs, and industry experts. These insights, conceptualized and hosted by former investment professionals, industry veterans and former scientists, help Guidepoint's institutional clients make well-informed decisions across sectors like healthcare, industrials, technology, consumer, and more. As an Equity Analyst, working in Shanghai you will be responsible for developing deep research coverage, facilitating expert-led discussions, and ensuring high-quality content creation. Reporting directly to the Director of Research, you will be instrumental in creating content that spans topics such as scientific basis of the platforms, competitiveness of existing and upcoming products of both public listed and private healthcare companies, industry landscape, regulatory decisions, product launches and go-to-market strategies. You will also lead efforts to recruit and vet experts, ensuring that the insights gathered are accurate, relevant, and valuable to our clients. What You'll Do: Research Coverage: Monitor a coverage universe of Chinese public and private companies in biotech, pharma, medtech and services. Industry Analysis: Track key market and business drivers, including material news flows, earnings releases, investor presentations, clinical trials, medical conferences, product launches within your coverage companies and therapeutic indications. Report Creation: Collect and organize clinical trial information and results, analyze the mechanisms of action (MOA) of drug candidates, investigate clinical paradigms for disease treatment in China, and prepare reports. Content Development: Create and moderate teleconferences featuring experts fro

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary: Ready to take your Medical Director career to the next level with a Fortune 6 company? Join Aetna, a CVS Health company, and make a meaningful impact on the health and well-being of Medicaid members across the country. Aetna operates Medicaid managed care plans in Arizona, Florida, Illinois, Kentucky, Louisiana, Maryland, Michigan, New Jersey, New York, Ohio, Oklahoma, Pennsylvania, Texas, Virginia, and West Virginia. We are seeking a Medical Director to join our centralized Medical Management team. This work-from-home position will primarily support Aetna Better Health of Louisiana , while also providing support across the other health plans as needed. In this role, you will partner with Medical Management staff to ensure timely, consistent, and clinically sound decisions for members and providers. Key responsibilities include: Utilization Management and medical necessity reviews Prior authorization and precertification determinations Concurrent review for inpatient and outpatient services Acute and post-acute care reviews Peer-to-peer consultations with treating providers Pharmacy reviews and first-level appeal determinations Collaboration with multidisciplinary clinical and operational teams The Medical Director also participates in a rotating on-c

Become a part of our caring community The Medical Director, National Outpatient Medicare leverages clinical expertise and medical judgment to review preauthorization requests for services. This role is responsible for evaluating moderately complex to complex cases, where analysis of clinical information and situational factors requires in-depth assessment and sound decision-making. As a Medical Director at Humana , you will use your clinical expertise and judgment to make meaningful coverage and care determinations that support quality, consistency, and compliance across the healthcare continuum. In this role, you will review requests for services, level of care, and site of service, using nationally recognized clinical guidelines, CMS policies, medical references, and internal clinical resources to guide decision-making. This position offers the opportunity to work on complex outpatient cases , review clinical documentation, and collaborate with both internal partners and external physicians to gather additional information and discuss determinations. You may also contribute to care management activities and, depending on the role, provide input on areas such as clinical documentation, coding, grievances and appeals, and outpatient services or equipment reviews. Beyond case review, this role provides the opportunity to build strong relationships with physicians, provider groups, facilities, and community partners in support of regional priorities. It is a strong fit for physicians who are interested in contributing to value-based care, population health, and care management strategies while working in a structured environment that values sound clinical judgment, collaboration, and operational excellence. Humana is seeking a Medical Director to

Opportunity Overview: We are looking for physicians who have expertise in Internal Medicine including medical and surgical clinical areas to deliver on Cohere’s program by determining the medical appropriateness of services by reviewing clinical information and applying evidence-based guidelines. Reporting to the Managing Medical Director for Cohere Health, this is a critical role in a company that is rapidly scaling to impact millions of patients. This is a fast-paced environment that favors people who are able to learn quickly, be hands-on, handle ambiguity, and communicate effectively with people of different backgrounds and perspectives. This is a remote-first role that may require travel to Boston, MA for new hire onboarding and occasional in-person team meetings and company events. What you’ll do: Support the clinical content team in reviewing the company’s clinical decision guidelines and evidence based literature Provide expert input on content for influencing physicians in medical care to improve the quality of patient outcomes Provide timely medical reviews that meet Cohere’s stringent quality and timeliness parameters Provide clinical determinations based on evidence-based criteria while utilizing clinical acumen and knowledge of evidence based literature and medical society guidelines Clearly and accurately document all communication and decision-making in Cohere workflow tools, ensuring a member and provider can easily reference and understand your decision Use correct templates for documenting medical necessity decisions during case review Conduct timely peer-to-peer discussions with treating providers to clarify clinical information and to explain review outcome decisions, including feedback on alternate treatment based on medical necessity criteria and evidence-based research Demonstrate the highest level of professionalism, accountability, and service in your interactions with Cohere teammates and providers Support projects specifi

We are looking for physicians who have expertise in Orthopedic Surgery to deliver on Cohere’s musculoskeletal and orthopedic programs by determining the medical appropriateness of services by reviewing clinical information and applying evidence-based guidelines. Reporting to the Managing Medical Director, Orthopedic Surgery for Cohere Health, and part of the review team that includes non-clinical intake specialists and nurses, this is a critical role in a company that is rapidly scaling to impact millions of patients. This is a fast-paced environment that favors people who are able to learn quickly, be hands-on, handle ambiguity, and communicate effectively with people of different backgrounds and perspectives. What you’ll do: Provide timely medical reviews that meet Cohere’s stringent quality parameters Provide clinical determinations based on evidence-based criteria while utilizing clinical acumen Clearly and accurately document all communication and decision-making in Cohere workflow tools, ensuring a member and provider can easily reference and understand your decision Use correct templates for documenting decisions during case review Meet the appropriate turn-around times for clinical reviews Conduct timely peer-to-peer discussions with treating providers to clarify clinical information and to explain review outcome decisions, including feedback on alternate treatment based on medical necessity criteria and evidence-based research Demonstrate the highest level of professionalism, accountability, and service in your interactions with Cohere teammates and providers Support projects specific to building the team's clinical expertise and efficiency, as delegated Support the team on operational improvements and member/provider experience involving clinical review tasks, as delegated What you’ll need: Completed US-based residency program in Orthopedic Surgery Board certification by appropriate specialty board as an MD or DO with a current unrestricted sta

Opportunity Overview: We are looking for physicians who have expertise in Cardiology and Vascular medical topics to deliver on Cohere’s Cardiology program by determining the medical appropriateness of services by reviewing clinical information and applying evidence-based guidelines. Reporting to the Managing Medical Director, Cardiovascular for Cohere Health, this is a critical role in a company that is rapidly scaling to impact millions of patients. This is a fast-paced environment that favors people who are able to learn quickly, be hands-on, handle ambiguity, and communicate effectively with people of different backgrounds and perspectives. What you’ll do: Support the clinical development team in reviewing the company’s clinical decision guidelines and evidence based literature Provide expert input on content and programs for influencing physicians in cardiovascular care to improve the quality of patient outcomes Provide timely medical reviews that meet Cohere’s stringent quality and timeliness parameters Provide clinical determinations based on evidence-based criteria while utilizing clinical acumen Clearly and accurately document all communication and decision-making in Cohere workflow tools, ensuring a member and provider can easily reference and understand your decision Use correct templates for documenting decisions during case review Conduct timely peer-to-peer discussions with treating providers to clarify clinical information and to explain review outcome decisions, including feedback on alternate treatment based on medical necessity criteria and evidence-based research Demonstrate the highest level of professionalism, accountability, and service in your interactions with Cohere teammates and providers Support projects specific to building the team's clinical expertise and efficiency, as delegated Support the team on operational improvements and member/provider experience involving clinical review tasks, as delegated What you’ll need U.S.-based resi

Medical Director, Medical Affairs — . Apply via Workday.

Medical Director - Medicaid Appeals — 26 Locations. Apply via Workday.

Medical Director (Medical Policy Ops-DRG) — CT - Work from home. Apply via Workday.

Medical Director - ENT — 51 Locations. Apply via Workday.

Medical Director MPO — 31 Locations. Apply via Workday.

Medical Director - Commercial — 41 Locations. Apply via Workday.

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Job Purpose and Summary: Join a mission-driven organization at a transformative moment in employer-sponsored health care. As Executive Medical Director, Clinical Business Solutions at Aetna, a CVS Health company, you will lead the clinical team that serves as the clinical voice to our Commercial plan sponsors, prospects, and their advisors, demonstrating how Aetna’s clinical capabilities reduce cost, improve population health, and strengthen the member and provider experience. Reporting directly to the Vice President, Chief Medical Officer, Commercial & Innovation, you will direct a national team of clinicians (MD, RN, NP) providing clinical support to Aetna’s National Accounts, Large Group, and Public & Labor businesses, in close partnership with Field and Account teams. You will lead and continuously improve the operations of the team to raise the level and quality of clinical support delivered to the Field, while sharing directly in its external work — including personally cultivating and holding relationships with key brokers, consultants, and plan sponsors. The role is deliberately bidirectional. You will bring the voice of the customer and the producer community back into the organization, partnering with Clinical Operations, Medical Affairs, Commercial Product, and others to ensure our clinical offerings reflect what the market requires. <p

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. The purpose of the Center Medical Director role is to lead the clinical team at their center in providing the best patient care and a great place to work in order to keep patients happy, healthy and out of the hospital. The Medical Director will practice primary care in our clinics alongside their provider colleagues at 80% clinical time and 20% administrative time. The CMD will have mission-critical leadership responsibilities, which include setting an example for how thoughtful primary care is practiced, serving as a formal mentor, coach, and advisor to providers in clinics, and participating in critical organizational-wide strategic initiatives. Core Responsibilities: The Center Medical Director is the medical leader for his/her center. In this role the CMD will have the following responsibilities: Support of Organizational Strategy Work in tight collaboration with the Practice Manager and Outreach Manager/Director to achieve our organizational objectives: Best Care Anywhere Unmatched Patient Experience Exceptional Growth Great Place to Work and Leader in DE&I Drive implementation of strategic initiatives. Follow direction from regional leadership (regional medical director or senior medical director) in collaboration with CMDs in the region to implement regional priorities and reach regional objectives.<br

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Senior Medical Director, Clinical Informatics Position Summary The Senior Medical Director for Clinical Informatics and Healthcare Delivery (HCD) Technology Product serves as the senior physician leader across healthcare delivery technical domains, providing clinical insight and technical expertise to drive end-to-end technology execution and ensure that Epic-enabled solutions advance core business outcomes. This role is the clinical expert and trusted physician advisor for teams across HCD technology, driving effective enterprise governance, improving clinician experience, enhancing patient outcomes, and supporting organizational strategic priorities. The Senior Medical Director will also serve as the product leader for two core HCD technology domains - Center Operations and Quality/Stars. The Senior Medical Director brings hands-on clinical and Epic build expertise, partners closely with operational and technical leadership across the enterprise to align the Epic roadmap with organizational strategy, has excellent clinical judgement and keeps patient experience, safety, and outcomes at the center of everything we do, and represents the clinical voice in enterprise governance, escalation, and innovation efforts. Key Responsibilities Clinical Product & Technology Leadership Serve as the senior product leader across Clinic Operations and Quality