Vice President, Operational Medical Director

Avalon Administrative Services LLC

35d•Remote

About The Position

The Medical Director is a senior clinical leader within Avalon’s Clinical Operations organization and serves as a key representative of the company on all clinical policy matters. This role is responsible for interpreting, applying, and advising on Avalon’s evidence-based clinical policies for clients, with particular focus on policy customization, reconciliation, and implementation support. The Medical Director acts as a trusted clinical advisor to internal teams and external partners, ensuring policy integrity, clinical appropriateness, and alignment with client and market needs. This position is eligible for remote work, but quarterly travel will be required to Avalon's corporate office located in Tampa, Florida.

Requirements

Degree in Medicine (MD/DO) - active or inactive license
Minimum of 5 years of experience in a clinical setting
Minimum of 3 years of experience in a payor or payment integrity vendor or similar organization
Experience in health plan, Medicare or State Medicaid plans with focus on reimbursement and/or coding required
Experience in supporting medical policy creation, enforcement and/or edits
Experience in the private sector/health plan operations as a Medical Director, with knowledge/understanding of reimbursement policies and medical coding
Demonstrated executive presence and comfortable working with clients directly
Strong analytical and problem-solving skills
Strong organizational skills and adaptive capacity for rapidly changing priorities and workloads
Professional demeanor with ability to properly handle confidential information
Ability to work well independently and in a team environment

Nice To Haves

Consulting experience within a healthcare coding and reimbursement company is a definite plus
Data analysis proficiency preferred using Excel, SQL,and/or Tableau
Prior experience in smaller, growth-stage company helpful

Responsibilities

Serve as Avalon’s senior clinical authority for policy interpretation, customization, and application, representing the organization on all clinical policy matters.
Lead policy presentations and reconciliations for new client implementations and existing client policy expansions, guiding clients through policy selection and adoption.
Act as a primary clinical liaison to health plan Medical Directors, Payment Integrity, and other senior clinical decision-makers, building trust and long-term partnerships.
Support Account Management teams in client strategy, complex clinical discussions, and escalations, jointly defining client mission, strategy, and value delivery.
Collaborate closely with the Scientific Affairs department, Coding and Translation teams, and Clinical Validation analysts to evaluate, validate, and refine policy logic and rule-based editing.
Provide expert clinical input on claims adjudication, policy application, and rule-based editing, ensuring accuracy, consistency, and clinical integrity.
Identify and support value creation and growth opportunities by aligning clinical policy capabilities with client needs and expansion opportunities.
Complete client-driven clinical inquiries and research requests in a timely manner, in partnership with the Chief Medical Officer and Clinical Policy teams.
Present clinical policy updates, changes, and emerging considerations to Avalon’s independent Clinical Advisory Board (CAB) and participate in quarterly CAB webinars.
Partner with the Network team and external providers to support policy discussions, laboratory capability reviews, and evaluation of emerging diagnostic technologies, reinforcing Avalon’s clinical credibility.