• Provide physician leadership for population health priorities, with a focus on high-risk and high-cost populations across lines of business. • Ensure the clinical appropriateness of risk stratification and intervention approaches, informing where and how resources are deployed. • Guide clinical priorities that improve outcomes, experience, and value across targeted populations, aligned to client and contractual goals. • Provide physician oversight for high-cost claimants and stop-loss reporting where required for contractual, audit, or customer needs. • Ensure clinical validity, accuracy, and consistency of external reporting and client deliverables. • Partner with analytics teams to streamline and standardize reporting processes, reducing manual physician involvement over time while maintaining clinical integrity. • Serve as the physician escalation point for complex, high-risk, or clinically ambiguous cases where physician input drives meaningful decisions or risk mitigation. • Define and refine criteria for physician involvement so effort is focused on high-impact scenarios rather than broad retrospective review. • Promote standards of practice, quality oversight, and exception-based engagement models that emphasize proactive, value-added physician review. • Identify and eliminate low-value physician work through automation, delegation, and clearer protocols, in partnership with operations and product teams. • Lead the transition from legacy case management support toward a focused, high-impact physician role concentrated on population health, governance, and critical escalations.

• Assist the Chief Medical Director to direct and coordinate the medical management, quality improvement and credentialing functions for the business unit. • Provides medical leadership of all for utilization management, cost containment, and medical quality improvement activities. • Performs medical review activities pertaining to utilization review, quality assurance, and medical review of complex, controversial, or experimental medical services, ensuring timely and quality decision making. • Supports effective implementation of performance improvement initiatives for capitated providers. • Assists Chief Medical Director in planning and establishing goals and policies to improve quality and cost-effectiveness of care and service for members. • Provides medical expertise in the operation of approved quality improvement and utilization management programs in accordance with regulatory, state, corporate, and accreditation requirements. • Assists the Chief Medical Director in the functioning of the physician committees including committee structure, processes, and membership. • Conduct regular rounds to assess and coordinate care for high-risk patients, collaborating with care management teams to optimize outcomes. • Collaborates effectively with clinical teams, network providers, appeals team, medical and pharmacy consultants for reviewing complex cases and medical necessity appeals. • Participates in provider network development and new market expansion as appropriate. • Assists in the development and implementation of physician education with respect to clinical issues and policies. • Identifies utilization review studies and evaluates adverse trends in utilization of medical services, unusual provider practice patterns, and adequacy of benefit/payment components. • Identifies clinical quality improvement studies to assist in reducing unwarranted variation in clinical practice in order to improve the quality and cost of care. • Interfaces with physicians and other providers in order to facilitate implementation of recommendations to providers that would improve utilization and health care quality. • Reviews claims involving complex, controversial, or unusual or new services in order to determine medical necessity and appropriate payment. • Develops alliances with the provider community through the development and implementation of the medical management programs. • May represent the business unit before various publics both locally and nationally on medical philosophy, policies, and related issues. • Represents the business unit at appropriate state committees and other ad hoc committees. • May be required to work weekends and holidays in support of business operations, as needed.

Role Description The Medical Science Director will serve as an internal scientific expert supporting products in an assigned therapeutic area. This role has responsibility for responding to Medical Information Requests, clinical support for the field sales teams, clinical support for customers, and the product development strategy. - Provide clinical and scientific expertise in the assigned therapeutic area to support internal teams, healthcare professionals (HCPs), and stakeholders. - Respond to medical information requests from healthcare providers, external partners, and internal departments with accurate, balanced, and timely information. - Lead and participate in advisory boards, KOL engagements, and scientific exchange to gather and provide insights for product development and medical strategy. - Collaborate with Clinical Operations to provide medical oversight and support for clinical trials including investigator-initiated studies. - Work closely with cross-functional teams (R&D, clinical development, regulatory affairs, commercial) to ensure medical insights are integrated into company strategies and product life cycle management. - Develop and deliver high-quality scientific presentations and materials for both internal and external audiences, including HCPs and key opinion leaders (KOLs). - Ensure that all medical communication, promotional material reviews, and activities comply with regulatory requirements, company policies, and ethical standards. - Provide ongoing medical and scientific training to internal teams, including sales and medical affairs, to ensure a deep understanding of oncology products and disease states. Company Description

• responsible for assigned aspects of medical policies and programs • performs medical reviews • interacts with the provider communities for assigned areas