Medical Director (Contract Role) - Military veterans preferred

About Avalon Healthcare Solutions:

Avalon Healthcare Solutions is the world's first and only Lab Insights company, bringing together our proven Lab Benefit Management solutions, lab science expertise, digitized lab values, and proprietary analytics to help healthcare insurers proactively inform appropriate care, reduce costs, and improve clinical outcomes. Working with health plans nationwide, the company covers over 44+ million lives and delivers 10-20% proven outpatient lab benefit savings. Avalon is pioneering a new era of value-driven care with its Lab Insights Program that captures, digitizes, and analyzes lab results in real-time to provide actionable insights for earlier disease detection, ensuring appropriate treatment protocols and driving down overall costs. 

Avalon is a portfolio company of Francisco Partners, a global private equity firm that specializes in investments in technology and technology-enabled service companies. Avalon is a high growth company where every associate has an opportunity to make a difference. 

Avalon has years of expertise in managing lab benefits and now is leveraging digitized lab results to drive quality clinical outcomes and proven savings.  When you look at how we bring this to life, we offer Lab Insights solutions that work together to arm you with critical lab-driven insights to accelerate your value-driven care success.  This is the first-of-its-kind suite of solutions to help you achieve the Triple Aim of improving the patient experience of care, improving the health of populations, and reducing the per-member cost of healthcare.

You will be part of a team that shapes a new market and business. Most importantly, you will help Avalon to achieve its mission and improve clinical outcomes and health care affordability for the people we serve.

For more information about Avalon, please visit www.avalonhcs.com.

About the Medical Director (Contract):

Avalon is seeking a Medical Director to support the review and development of clinical policies, internal and client facing documentation and guides, and coding frameworks. This role will serve as a clinical voice in policy evaluation and code editing initiatives, ensuring alignment with Avalon’s policy taxonomy and clinical standards. The ideal candidate will bring a strong background in medicine, coding, and healthcare operations. The Medical Director will provide expert clinical and coding support for Avalon’s policy development initiatives. This role is responsible for reviewing translation guides, contributing to code editing expansion efforts, and responding to clinical inquiries from clients. The Medical Director will ensure that clinical efficacy is accurately reflected in policy language and that coding structures align with Avalon’s taxonomy.

This position is eligible for remote work, but occasional travel may be required to Avalon's corporate office located in Tampa, Florida.

Medical Director (Contract) – Essential Functions and Responsibilities:

• Review and validate translation guides submitted by project teams, ensuring clinical accuracy and policy alignment.
• Serve as the clinical voice in the initial review of code editing expansion projects.
• Oversee large internal policy review project, including final review of coding and translation of comprehensive lab policies into translational documents.
• Evaluate references and rationales for each policy statement to ensure clinical and scientific integrity.
• Assist in triaging and responding to client team questions regarding clinical policies.
• Act as a liaison between internal teams and clients to validate comprehensive policy, coding & translation (C&T), and configuration.
• Use Excel to review and validate client/claim data and summarize findings for internal and client use.
• Participate in implementation policy reconciliation calls, serving as the clinical voice when clients evaluate adoption of Avalon policies, in an as needed basis in support of Chief Medical Officer.
• Support ad hoc clinical requests as directed by the Chief Medical Officer.

Medical Director (Contract) – Minimum Qualifications:

• M.D. or D.O.
• Experience in healthcare settings such as billing, advocacy, laboratory science, or claims processing
• Familiarity with laboratory policies and translation guides
• Certified Professional Coder (CPC)
• Demonstrated experience in clinical policy review and development
• Strong understanding of coding systems and healthcare documentation

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