Medical Director Scientific Affairs

Hi, we're the company. We're hiring a Medical Director Scientific Affairs to join our Clinical Affairs team.

The company is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members. We started the company in 2012 to create the kind of health insurance company we would want for ourselves—one that behaves like a doctor in the family.

About the role

The Medical Director Scientific Affairs provides strategic leadership to the Clinical Policy team, ensuring medical and pharmacy policies are rigorously evidence-based and aligned with current clinical advancements. This role manages the full policy lifecycle, from literature evaluation to final execution. The Medical Director, Scientific Affairs directs the company's clinical publishing efforts, and serves as a cross-functional scientific authority across the organization.

You will report into our Vice President, Clinical Affairs.

Work Location:  This position is fully remote and open to candidates residing in the U.S., excluding Alaska; Delaware; Hawaii; Louisiana; Montana; North Dakota; Oklahoma; West Virginia; Wyoming; and U.S. Territories. Daily work is completed from your home office, with occasional travel required for team meetings and company events. #LI-Remote

Pay Transparency:  The base pay for this role is: $237,719- $312,006 per year. You are also eligible for employee benefits, participation in the company's unlimited vacation program, company equity grants and annual performance bonuses.

Responsibilities

• Serve as the primary evidence-based subject matter expert, translating clinical research into actionable strategies to elevate care quality across the organization.

• Lead the research, development, revision, and clinical accuracy of all medical, utilization management (UM), and pharmacy coverage policies.

• Advise executive leadership on emerging medical therapies, complex clinical trends, and population health utilization patterns using data-driven insights.

• Support the development of clinical and lifestyle products through the production of evidence based research tailored to target populations.

• Foster academic partnerships to advance and publish clinical research leveraging health plan population data.

• Lead the systematic review of major specialty society guidelines (e.g., ASCO, ACC, AACE), ensuring policies reflect established standards of care and objective evidence evaluation.

• Establish, maintain, and enforce the formal framework for grading clinical evidence, ensuring all medical and pharmacy policies are anchored in high-quality, peer-reviewed literature.

• Oversee Clinical Advisory Subcommittees - setting agendas, presenting clinical evidence packages, and driving expert consensus to guide policy decisions.

• Partner with Pharmacy Services (P&T Committee), Legal, and Compliance to seamlessly integrate coverage policies that meet or exceed NCQA standards and state/federal mandates.

• Support interactions with federal and state regulatory bodies (e.g., FDA, CMS, State DOIs) as needed.

• Compliance with all applicable laws and regulations.

• Other responsibilities as assigned.

Requirements

• 10+ years working in relevant fields.

• 6+ years clinical policy experience in health insurance, PBM, or other clinical guideline development organization.

• 4+ years experience in clinical policy drafting and development.

• 4+ Years of experience leading, chairing, or facilitating multi-disciplinary clinical committees or advisory subcommittees.

• 4+ years publishing in relevant fields.

• 3+ years of experience communicating with executives and interacting with all levels of the organization.

• 3+ years of leadership experience as a people manager.

• 1+ years of experience with medical coding terminologies (HCPCs, CPT, ICD-10).

• Medical Degree (MD or DO): Required from an accredited school of medicine or osteopathic medicine.

• Board Certification: Active board certification recognized by the American Board of Medical Specialties (ABMS) or the American Osteopathic Association (AOA).

Bonus points

• Demonstrated experience analyzing clinical trials and medical literature.

• A track record of publishing in peer-reviewed clinical journals or serving on an Institutional Review Board (IRB) or Clinical Practice Guideline panel is highly desirable.

• PhD or Masters in Clinical Research.

This is an authentic the company job opportunity.

At the company, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. We're on a mission to change health care -- an experience made whole by our unique backgrounds and perspectives.

Pay Transparency:  Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements.

Artificial Intelligence (AI): Our AI Guidelines outline the acceptable use of artificial intelligence for candidates and detail how we use AI to support our recruiting efforts.

Reasonable Accommodation: the company applicants are considered solely based on their qualifications, without regard to applicant’s disability or need for accommodation. Any the company applicant who requires reasonable accommodations during the application process should contact the company Benefits Team [link for members] to make the need for an accommodation known.

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