Medical Director, PinnacleCare

Sun Life U.S. is one of the largest providers of employee and government benefits, helping approximately 50 million Americans access the care and coverage they need. Through employers, industry partners and government programs, Sun Life U.S. offers a portfolio of benefits and services, including dental, vision, disability, absence management, life, supplemental health, medical stop-loss insurance, and healthcare navigation. We have more than 6,400 employees and associates in our partner dental practices and operate nationwide.
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* Job Description:

** Sun Life embraces a hybrid work model that balances in-office collaboration with the flexibility of virtual work. Internal candidates are not required to relocate near an office.
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* The opportunity:

** The
** Medical Director
** serves as the clinical and strategic leader for the organization’s medical advisory operations. This physician ensures the highest standards of medical accuracy, clinical insight, and operational effectiveness across the company’s services to shape medical strategy and ensuring the highest quality guidance for members navigating complex healthcare decisions. The Medical Director does not provide direct patient care, but instead provides oversight, clinical judgment, and expert guidance to support advisors, members, research teams, and clinical relations
** How you will contribute:
**** Strategic Development & Collaboration
*** Collaborate with organizational leadership to expand and manage Medical Advisory Board and provider referral network
* Collaborate with the Chief Medical Officer (CMO) on innovative ways to increase member engagement, and realized value to drive membership renewal and persistency
* Collaborate with executive leadership to refine the company's medical strategy, product development, service enhancements, content standards, and client deliverables
* Stay current with emerging medical trends, therapies, and technologies relevant to advisory services
* Assist in shaping Pinnacle Care’s value proposition and differentiation in the market place
** Clinical Leadership & Advisory
*** Provide medical advisory direction and management
* Serve as a senior escalation point for complex, high-acuity, and sensitive clinical cases
* Recommend appropriate physician specialties and centers of excellence based on individual member medical needs
* Provide phone support for members with complex, multi-system medical conditions when necessary
* Supervise the remote second opinion program for members and develop frameworks and criteria to guide when a second opinion or further evaluation is indicated
** Team Management & Leadership
*** Manage the physician chart review team
* Oversee medical services team and coordinate Pinnacle Care physician on-call program
* Mentor, coach, and support assistant medical directors
** Quality Assurance & Standards
*** Lead development of medical review processes, clinical standards, and quality assurance programs
* Partner with director of research on content and accuracy of medical intelligence research reports
* Evaluate and recommend appropriate centers of excellence and subspecialty referrals
** Education & Training
*** Provide medical education curriculum for advisors and team leaders and when necessary with members for critical new or evolving medical information (ie epidemics, breakthroughs)
* Mentor interns assigned to Pinnacle Care for clinical content projects
** What you will bring with you:
*** Ability to work with a diverse range of people
* MD from an accredited medical school with active, unrestricted U.S. medical licensure
* Min 5 years of clinical experience
* Certification by an ABMS board
* Active and unrestricted medical license
* Strategic thinker with strong attention to detail
* Empathetic communicator able to bridge clinical and lay perspectives
* Collaborative leader who thrives in a multidisciplinary, fast-paced environment
* Committed to medical accuracy, ethical standards, and continuous improvement
* Proficiency with Microsoft office Suite
* Strong problem-solving, organizational and analytical skills
** Salary:**$162,700-$244,100

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