Pharmacy Lead – Appeals Medical Director

Medical DirectorMedical DirectorFull TimeRemoteSeniorTeam 10,001+Since 1961H1B SponsorCompany SiteLinkedIn

Location

United States

Posted

22 hours ago

Salary

$270.8K - $378.8K / year

Seniority

Senior

Professional CertificateEnglish

Job Description

• Oversee and supervise the VSP Physician Program , ensuring high-quality performance across: Quality review, Hiring and onboarding, Training and skill development, Midyear performance evaluation, Workforce management (WFM), Productivity metric design and monitoring, Escalated clinical guidance • Field and respond to AllMed Clinical Questions , ensuring timely and accurate clinical guidance • Serve as a clinical SME for the Core Physician and Pharmacist Appeals Teams , providing support on complex clinical questions and partnering to develop more efficient workflows • Function as a trainer for new hires within the Core Physician Appeals Teams • Participate in audit activities as both a researcher and a team oversight lead , ensuring accuracy, readiness, and strong clinical rationale in audit response materials

Job Requirements

  • MD or DO with active, unrestricted medical license
  • Strong clinical acumen with experience interpreting complex medical and pharmacy evidence
  • Prior experience in utilization management, appeals, audit, or clinical operations preferred
  • Demonstrated ability to lead teams, mentor physicians, and manage performance
  • Creative problem‑solver with a continuous improvement mindset
  • Strong communication skills and ability to collaborate across multi‑disciplinary teams

Benefits

  • medical, dental and vision benefits
  • 401(k) retirement savings plan
  • time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave)
  • short-term and long-term disability
  • life insurance

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