- Initiate and oversee the development and execution of an annual plan for medical management, ensuring alignment with the mission and goals of the Plan, financial resources, and government contract requirements with the Department of Defense.
- Establish and execute utilization management policies and work plans with the Plan's key stakeholders to achieve medical management strategies.
- Establish and implement population health initiatives, including disease management programs, health risk screening, preventive health activities, and specialized case management.
- Ensure compliance with all federal, state, and regulatory requirements, including HIPAA, DHA, and Department of Defense regulations.
- Develop and implement policies to enhance patient safety, improve care quality, and integrate best clinical practices.
- Collaborate with Provider Relations to establish, implement, and oversee education and outreach to network providers to align the Plan's medical management objectives with clinical practice in the network.
- Participate in the Quality of Care Committee.
- Provide strategic leadership in medical policy, care coordination, and quality assurance.
- Manage and lead the clinical team.
- Partner with Human Resources to oversee hiring, training, and performance management of department employees.
- Initiate and oversee the development and execution of an annual clinical quality management plan to achieve optimal health outcomes and exceptional service.
- Establish and oversee implementation within USFHP of quantitative outcome measures that meet HEDIS requirements and validate Plan performance.
- Track utilization trends and work with the Plan leadership team to identify outliers that may require focused review.
- Establish and execute utilization management policies with key stakeholders to achieve the medical management strategies for self-insured products.
- Collaborate with the Chief Pharmacy Officer in developing policies and strategies for the cost-effective delivery of pharmacy benefits.
- Oversee medication management initiatives to improve prescription drug therapy and cost efficiency.
- Participate as the USFHP, Brighton Marine, physician representative in all national forums and workgroups related to medical and quality management for the US Family Health Plan.
- Develop and maintain relationships with key stakeholders, including hospitals, payers, and government agencies.
- Represent BMI in professional and regulatory forums.
- Doctor of Medicine (MD) degree or Doctor of Osteopathic Medicine (DO) degree.
- Minimum 5 years of experience in clinical leadership, managed care, and healthcare administration.
- Active and unrestricted medical license.
- Board certification in a relevant medical specialty.
- Strong leadership, strategic planning, and decision-making skills.
- Expertise in medical management, utilization review, and provider engagement.
- Knowledge of healthcare regulations, clinical operations, and patient safety.
- Proficiency in healthcare data analytics and performance measurement tools.
- Ability to develop and implement clinical quality initiatives.
- Commitment to patient-centered care.
-
· Be part of our team · As a Medical Director/Senior Medical Director and member of our Clinical Development team, you will support the planning and execution of full life-cycle development of our antibody-drug conjugates (ADCs) global clinical trials. You will lead all clinical ...
Boston (USA)1 week ago
-
The Medical Director will report to the Senior Medical Director of Utilization Management and support the staff of the Office of Clinical Affairs in various areas such as medical management daily medical necessity reviews evaluation of medical policy utilization trend management ...
Boston $173,000 - $250,000 (USD)1 month ago
-
+The Medical Director will report to the Senior Medical Director of Utilization Management, Member Appeals & Grievances, and Medical Policy (Senior Medical Director of Utilization Management) and support the staff of the Office of Clinical Affairs in the areas of medical manageme ...
Boston1 month ago
-
Job Description · If you are interested in applying for this job, please make sure you meet the following requirements as listed below. · Intention Healthcare, an Essen Health Care company, is a specialized medical group dedicated to providing accessible medical care to vulnerabl ...
Boston $260,000 - $380,000 (USD) per year20 hours ago
-
Join our Boston or Plymouth, MA Team · Site Medical Director- FM Physician · Salary Range $230,000 to $280,000 + benefits · Requirements to apply: · Current MA MD or DO license · Board Certified Family Medicine physician; completion of accredited residency required · Minimum 5 ye ...
Boston $260,000 - $380,000 (USD) per year10 hours ago
-
+h2>Job summary · The Opportunity Our client seeks a forward-looking and compassionate Medical Director to serve as the clinical heartbeat of a total health community. · +Oversee medical teams of licensed independent practitioners, including physicians and nurse practitioners. · ...
Boston $175,000 - $250,000 (USD)3 weeks ago
-
+We are seeking a Medical Director who thrives at the intersection of clinical excellence and social justice. · +Build Trust: Establish strong partnerships with the C-Suite and build credibility across the clinical and quality teams. · Optimize Workflows: Connect health center op ...
Greater Boston3 weeks ago
-
We are seeking a dynamic and compassionate Medical Director to join our team. You will provide leadership, guidance, and direction to clinical staff, fostering a collaborative environment while maintaining the highest standards of patient care. · This is an exciting opportunity t ...
Boston $200,000 - $300,000 (USD)1 month ago
-
Medical Director / Attending Physician · Location: Boston, MA · Schedule: Full Time · Salary: $250,000 - $300,000 · About Infinite Medical P.C. · Infinite Medical P.C. is a nationwide network of advanced practice providers and specialty clinicians committed to delivering high-q ...
Boston $250,000 - $300,000 (USD)1 day ago
-
· Medical Director / Attending Physician · Location: Boston, MA · Schedule: Full Time · Salary: $250,000 - $300,000 · About Infinite Medical P.C. · Infinite Medical P.C. is a nationwide network of advanced practice providers and specialty clinicians committed to delivering hi ...
Boston, MA $260,000 - $380,000 (USD) per year36 minutes ago
-
We are seeking a Medical Director to provide leadership to our clinical staff and maintain a clinical practice of 24 hours weekly. · Current MA MD/DO License · Family Physician highly desired · ...
Boston1 month ago
-
· Bond Vet is on a mission to strengthen the human-animal bond through better pet care. We offer primary and urgent care, so we're there for pets when they need us most. Our clinics are designed with pets and people in mind: warm, friendly, and highly sniffable. We balance this ...
Boston, MA $260,000 - $380,000 (USD) per year2 days ago
-
Title: Medical Director · Job Type: Full-time · Location: Hybrid 4 days per week in Brighton, MA office; 1 day remote from home · FLSA Status: Exempt · Position Summary · The Medical Director oversees all medical and clinical operations at BMI, Inc., ensuring the highest standard ...
Boston $260,000 - $380,000 (USD) per year2 days ago
-
Title: Medical Director · Job Type: Full-time · Location: Hybrid 4 days per week in Brighton, MA office; 1 day remote from home · FLSA Status: Exempt · Position Summary · The Medical Director oversees all medical and clinical operations at BMI, Inc., ensuring the highest standard ...
Boston $200,000 - $260,000 (USD)4 days ago
-
The largest community health center in the country is seeking an experienced Medical Director to lead their team. · ...
Boston1 month ago
-
· Medical Director · Location: Boston, MA · Schedule: Full Time · Salary: $200,000 - $300,000 · About Infinite Medical P.C. · Infinite Medical P.C. is a nationwide network of advanced practice providers and specialty clinicians committed to delivering high-quality, proactive c ...
Boston, MA $260,000 - $380,000 (USD) per year1 week ago
-
We are seeking a dynamic and compassionate Medical Director to join our team. · Provide ongoing oversight, mentorship, and clinical guidance to the medical staff to maintain high standards of care · Foster a collaborative environment that promotes best practices and continuous pr ...
Boston, MA3 weeks ago
-
Job Description · General Summary: · The Medical Affairs Strategy Medical Director will provide medical leadership for the Povetacicept programs. Povetacicept (pove) is an enhanced, dual BAFF/APRIL inhibitor in pivotal development for the treatment of IgA Nephropathy (IgAN), that ...
Boston $236,800 - $355,200 (USD)1 week ago
-
The Medical Director will collaborate closely with Adult Medicine leadership team and assure timely and ongoing communication amongst leadership and departmental staff administrative clinical development of medical staff in Adult Medicine overseeing optimizing patient safety pati ...
Boston3 weeks ago
-
Join our Boston or Plymouth, MA Team · Site Medical Director- FM Physician · Salary Range $230,000 to $280,000 + benefits · Requirements to apply: · Current MA MD or DO license · Board Certified Family Medicine physician; completion of accredited residency required · Minimum 5 ye ...
Boston $260,000 - $380,000 (USD) per year2 days ago
-
· Bond Vet is on a mission to strengthen the human-animal bond through better pet care. We offer primary and urgent care, so we're there for pets when they need us most. Our clinics are designed with pets and people in mind: warm, friendly, and highly sniffable. We balance this ...
Boston, MA $260,000 - $380,000 (USD) per year2 days ago
Medical Director - Boston - Brighton Marine
Description
Title: Medical Director
Job Type: Full-time
Location: Hybrid 4 days per week in Brighton, MA office; 1 day remote from home
FLSA Status: Exempt
Position Summary
The Medical Director oversees all medical and clinical operations at BMI, Inc., ensuring the highest standards of patient care, regulatory compliance, and innovation. This role is responsible for the organization's medical management strategy, providing clinical insight in areas such as utilization management, case management, provider network, contracting, pharmacy, and service operations (claims). The Medical Director also collaborates with stakeholders to optimize clinical effectiveness and integrate medical advancements into the organization's healthcare offerings.
Key Responsibilities
Medical Operations & Compliance
Leadership
Clinical Quality & Management
Pharmacy & Cost Management
Stakeholder & External Relations
Qualifications
Education & Experience
Licensure & Certifications
Skills & Competencies
Physical Nature of the Job
Some elements of the job are sedentary, but the employee will be required to stand for periods of time or move throughout the campus.
Equal Opportunity Employer Statement
Brighton Marine is an Equal Opportunity Employer. We prohibit discrimination and harassment of any kind based on race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), national origin, age, disability, genetic information, protected veteran status, or any other characteristic protected by federal, state, or local law. We strongly encourage applications from veterans and individuals with disabilities. Accommodations are available upon request for candidates taking part in all aspects of the selection process.
Work Authorization
Candidates must be authorized to work in the United States without sponsorship now or in the future.
-
Medical Director/Senior Medical Director
Only for registered members Boston (USA)
-
Medical Director
Only for registered members Boston
-
Medical Director
Only for registered members Boston
-
Medical Director
Essen Health Care- Boston
-
Medical Director
Cross Country Healthcare- Boston
-
Medical Director
Only for registered members Boston
-
Medical Director
Only for registered members Greater Boston
-
Medical Director
Only for registered members Boston
-
Medical Director
Only for registered members Boston
-
Medical Director
Only for registered members Boston, MA
-
Medical Director
Only for registered members Boston
-
Medical Director
Only for registered members Boston, MA
-
Medical Director
Brighton Marine- Boston
-
Medical Director
Only for registered members Boston
-
Medical Director
Only for registered members Boston
-
Medical Director
Only for registered members Boston, MA
-
Medical Director
Only for registered members Boston, MA
-
Medical Director
Only for registered members Boston
-
Medical Director
Only for registered members Boston
-
Medical Director
Only for registered members Boston
-
Medical Director
Only for registered members Boston, MA