This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description As Medical Director, Scientific Affairs, you will support Headway’s health plan relationships and payer strategy to continue expanding Headway’s provider network impact. You’ll work cross-functionally with teams across Headway, including: - Payer - Product - Growth - Marketing - Data & Analytics As the only tech-enabled behavioral health Managed Services Organization (MSO) built with entirely in-house software, Headway has an unprecedented opportunity in the clinical space. Today, we support more than 60k Clinicians and hundreds of thousands of patients. Building a best-in-class digital product will impact clinicians and patients nationwide. Qualifications - You are a psychiatrist with 5+ years of experience as a clinician in a fast-paced, high-growth business. - You bring 2+ years of experience working in payer or partnership roles, ideally in technology environments. - You are an industry influencer with a passion for reimagining how behavioral health is delivered and measured. - You are a proven thought leader with peer-reviewed publications, mainstream media articles, and/or other expert content. - You’re effective at communicating clinical information to non-clinical staff and can distill complex clinical processes and language. - You have strong analytical skills and experience in analyzing and synthesizing data & research insights. - You are a creative thinker who loves exploring data in new ways. - You are familiar with clinical quality measurement and peer review systems in healthcare. - You are a collaborator eager to work with product, operations, and sales teams. - You have general familiarity with healthcare regulations and laws surrounding corporate practice of medicine. - You have past experience with a healthcare tech company and/or startup. - You are based on or near the East Coast and are willing to travel. Requirements - Support Headway health plan partnerships and strategy. - Promote external relations with Payers through relationship building, presentations/reporting, sales meetings, and conference participation. - Drive creative, innovative, exploratory data analyses to prove patient outcomes and generate novel insights. - Develop a critical understanding of how mental health clinicians utilize digital tools. - Work collaboratively with cross-functional teams including product, design, growth, marketing, payer relations, data & analytics, and operations. - Be willing to travel. Benefits - Equity Compensation - Medical, Dental, and Vision coverage - HSA / FSA - 401K - Work-from-Home Stipend - Therapy Reimbursement - 16-week parental leave for eligible employees - Carrot Fertility annual reimbursement and membership - 13 paid holidays each year as well as a Holiday Break during the week between December 25th and December 31st - Flexible PTO - Employee Assistance Program (EAP) - Training and professional development

• Support Headway health plan partnerships and strategy • Promote external relations with Payers through relationship building, presentations/reporting, sales meetings, and conference participation • Drive creative, innovative, exploratory data analyses to prove patient outcomes, generate novel insights, shape strategic direction, and demonstrate scientific and strategic value to customers • Develop a critical understanding of how mental health clinicians utilize digital tools to deliver high quality care and document in a compliant manner • Work collaboratively with cross functional teams including product, design, growth, marketing, payer relations, data & analytics, and operations • Be willing to travel.

• Perform detailed, medical record reviews (e.g., 30-day readmissions) to ensure documentation supports the services rendered and aligns with medical necessity guidelines. • Apply your clinical expertise to review and validate clinical decision-making by vendors and providers to ensure proper reimbursement for services provided. • Coach and train other clinical decision-makers, helping them improve the proper selection and application of medical necessity guidelines. • Leverage your expertise in peer review committees to support and contribute to quality improvement teams and initiatives. • Serve as the key clinical leader for cost containment initiatives, collaborating with data analytics, claims, and FWA departments to investigate and act on aberrant trends. • Champion initiatives to reduce unnecessary hospital days, avoidable ER visits, and inappropriate high-cost drug utilization. • Collaborate with providers through periodic case reviews to ensure consistent and standardized decision-making. • Please note: This role is focused on clinical case review and does not require after-hour calls, holidays, or weekends.

• The Medical Director, Utilization Management, will be responsible for the evaluation of all outpatient referrals and inpatient direct admissions for medical appropriateness. • The physician will utilize Local and National Medicare Coverage Determinations, Milliman Care Criteria, Clover Health’s medical policies reviews to determine medical necessity or if an alternate treatment plan is required for our members. • Successfully completes all required new hire training modules and certifications • Demonstrates a foundational understanding of Clover Health's medical policies, guidelines, and utilization management processes • Begins to independently review cases with increasing efficiency and accuracy, requiring minimal oversight • Establishes positive working relationships with team members and key stakeholders • Consistently meets or exceeds productivity targets for case reviews and determinations • Maintains a high level of accuracy in medical necessity determinations and documentation • Actively participates in team meetings and contributes to process improvement discussions • Demonstrates a comprehensive understanding of complex medical cases and escalates issues appropriately.