Role Description The Medical Director provides physician support to Enterprise Clinical Services operations, the organization responsible for the initial clinical review of service requests for Enterprise Clinical Services. The Medical Director collaborates with Enterprise Clinical Services leadership and staff to establish, implement, support and maintain clinical and operational processes related to benefit coverage determinations, quality improvement and cost effectiveness of service for members. The Medical Director's activities primarily focus on the application of clinical knowledge in various utilization management activities with a focus on post-service benefit and coverage determination or medical necessity (according to the benefit package), and on communication regarding this process with both network and non-network physicians, as well as other Enterprise Clinical Services. The Medical Director collaborates with a multidisciplinary team and is actively involved in the management of medical benefits. The collaboration often involves the member’s primary care provider or specialist physician. It is the primary responsibility of the medical director to ensure that the appropriate and most cost-effective quality medical care is provided to members. You’ll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities: - Conduct coverage reviews based on individual member plan benefits and national and proprietary coverage review policies, render coverage determinations. - Document clinical review findings, actions, and outcomes in accordance with policies, and regulatory and accreditation requirements. - Engage with requesting providers as needed in peer-to-peer discussions. - Be knowledgeable in interpreting existing benefit language and policies in the process of clinical coverage reviews. - Participate in daily clinical rounds as requested. - Communicate and collaborate with network and non-network providers in pursuit of accurate and timely benefit determinations for plan participants while educating providers on benefit plans and medical policy. - Communicate and collaborate with other internal partners. - Call coverage rotation. Qualifications - M.D. or D.O. - Active unrestricted license to practice medicine. - Board certified Medical Genetics and Genomics OR Board certified in Family Medicine or Internal Medicine with training in genetics (Board certifications must be through the American Board of Medical Specialties (ABMS) or the American Osteopathic Association (AOA)). - Ability to obtain additional licenses as needed. - 5+ years of clinical practice experience after completing residency training. - Proven sound understanding of Evidence Based Medicine (EBM). - PC skills, specifically using MS Word, Outlook, and Excel. - Participate in rotational holiday and call coverage. Requirements - Licensed in MA or MN. - Utilization Management or clinical coverage review experience for an insurance or managed care organization OR 2+ years of Hospitalist Experience. - Experience doing reviews and Utilization Management for inpatient stays. - Innovative problem-solving skills. - Proven presentation skills for both clinical and non-clinical audiences. - Demonstrated excellent oral, written, and interpersonal communication skills, facilitation skills. - Current licensure in New Mexico, Arizona or Indiana. Benefits - Comprehensive benefits package. - Incentive and recognition programs. - Equity stock purchase. - 401k contribution (all benefits are subject to eligibility requirements). - Salary range from $248,500 - $373,000 annually based on full-time employment. Application Deadline This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

• Provide medical leadership and oversight across all phases of development • Partner with clients and internal teams to support business development • Provide oversight of medical monitoring activities • Serve as Global Lead, Regional or Program Project Physician across multiple indications • Prepare materials for and actively participate in investigator meetings

• Provide medical leadership to the study teams, including creating clinical trial protocols while implementing the latest scientific information • Contribute to site selection • Involved in review and approval of study protocols and amendments, Clinical Study Reports (CSRs), Informed Consent Forms (ICFs), Case Report Forms (CRFs), protocol deviation decisions and other clinical documents as required for the conduct of clinical trials • Ensure medical validity of each individual primary endpoint as well study subject safety, while ensuring medical issues are identified early • Pro-active customer concern and correction of issues in consultation with the Global Medical Indication Lead • Consults with internal groups and support staff regarding procedural and budgetary items and the necessity for change due to any subsequent protocol amendments • Serves as chief liaison between sponsor and all PPD internal departments performing the required tasks during all study phases • Educates Investigator sites by delivering a protocol specific lab procedures presentation and demonstration during an investigator meeting • Controls, handles and follows day to day activities during the course of the clinical trial to resolve any issues and answer queries • Medical point of contact for all internal and external stakeholders: interact with the investigators as needed, answer questions of IRBs and Health Authorities, prepare and present material to the study executive and independent safety committee if applicable; medical training of site staff at Investigator meetings; CRA training in new indications • Ensure study compliance for all medical aspects by understanding and applying all relevant SOPs and GCP • Closely collaborate with the cross functional study team members in order for medical risks, issues, and results to be clear to all involved parties

Role Description The Medical Director -BH per diem will support the staff of the Office of Clinical Affairs and Behavioral Health teams in the areas of medical management daily medical necessity reviews, evaluation of medical policy, utilization trend management, quality, appeals and grievances, and pharmacy reviews. Key Functions/Responsibilities - Provides clinical case review, consultation and oversight for all utilization management activities in a fashion that is compliant with all federal, state, and NCQA requirements. - Conducts review of prior authorizations, concurrent reviews and retrospective medical necessity reviews that do not meet standard criteria and determines coverage. - Works with the Senior Medical Director of Behavioral Health to identify appropriate use of InterQual criteria and Medical Policy. - Works with the Senior Medical Director to ensure consistent medical decision making for all physician reviewers, including the contracted physicians. - Conducts clinical review of appeals and grievances in a fashion that is compliant with all federal, state and NCQA requirements. - Develops and supports clinical initiatives to support department quality improvement and utilization management goals. - Reviews claims involving complex, controversial, or unusual or new services in order to determine medical necessity and appropriate payment. - Collaborates with hospital physicians, medical directors, primary care physicians and nurse case managers in daily activities and initiatives to improve the health of the population, the quality and experience of care our members receive, and lower the overall cost of care at the population level. - Participates in and chairs clinical committees as assigned by the Senior Medical Director of Behavioral Health. - Supports quality, and pharmacy committees and activities. - Provides input to the strategic planning process for the Office of Clinical Affairs as requested. - Represents the Chief Medical Officer or Senior Medical Directors in Massachusetts, New Hampshire and other locations as requested. Supervision Exercised - Indirect technical direction is provided to the organization. Supervision Received - General direction is received weekly. Qualifications - Graduate as a Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) from an accredited allopathic or osteopathic medical school. - 8-10+ years of related experience is required including a minimum of 5 years direct clinical experience. - 3 years experience in medical management in a managed care setting is ideal. Preferred/Desirable - Pre-employment background check. - Active or lifetime board certification in psychiatry (Child and Adolescent specialty) from the American Board of Psychiatry and Neurology or the American Osteopathic Board of Neurology and Psychiatry. - Current unrestricted licensure as an MD in the Massachusetts and New Hampshire is required, or able to obtain in a reasonable timeframe. - No restriction on participation in Medicare or Medicaid programs. Competencies, Skills, and Attributes - Excellent demonstrated clinical skills and knowledge. - Excellent written and verbal communication skills. - Comprehensive knowledge of accrediting organizations such as NCQA. - Comprehensive knowledge of InterQual protocols, HEDIS, and other quality measures. - Knowledge of Medicare and state Medicaid regulations, guidelines, and standards. - Proven leadership skills and relationship building. - Knowledge of managed care principles and processes. - Ability to work independently with intermittent supervision. - Adhere to appropriate turn-around-times and deadlines while maintaining results of high quality and reliability. Working Conditions and Physical Effort - Work is normally performed in a typical remote interior/office work environment. - No or very limited physical effort required. No or very limited exposure to physical risk. - Ability to travel to locations within New Hampshire and Massachusetts. - Regular and reliable attendance is an essential function of the position. Compensation Range $150.00/ Hour This range offers an estimate based on the minimum job qualifications. However, our approach to determining base pay is comprehensive, and a broad range of factors is considered when making an offer. This includes education, experience, skills, and certifications/licensure as they directly relate to position requirements; as well as business/organizational needs, internal equity, and market-competitiveness. In addition, WellSense offers generous total compensation that includes, but is not limited to, benefits (medical, dental, vision, pharmacy), merit increases, Flexible Spending Accounts, 403(b) savings matches, paid time off, career advancement opportunities, and resources to support employee and family wellbeing. Note: This range is based on Boston-area data, and is subject to modification based on geographic location.