Vice President, Medical Director

Introduction

Zenith is a team of Workers' Compensation Specialists committed to helping businesses succeed by protecting against the financial and human consequences of workplace injuries, providing for the needs of injured employees and making the workplace safer. To distinguish ourselves as the desired provider of Workers' Compensation Insurance, values such as collaboration, work-life balance, and integrity are placed at the center of all our operations.

In addition, Zenith supports career advancement through a dedication to ongoing learning and development. An individual coming to Zenith will not only receive competitive compensation and a comprehensive benefits package, but continuous opportunities to grow as a professional.

This role is eligible for either a hybrid work schedule at any Zenith office outside of California or otherwise can sit remotely.

The Vice President, Medical Director serves as the clinical leader for the non-California offices and provides strategic oversight of medical management activities supporting workers' compensation claims operations in conjunction with the California Medical Director and other leaders. The role partners closely with Claims, Underwriting, Safety & Health, Legal, and Executive Leadership to improve the quality and cost of injured worker outcomes, manage medical severity, support evidence-based treatment decisions, and strengthen claim performance.

Responsible for strategic clinical relationships with medical providers and facilities in order to drive quality, appropriate and necessary care for injured workers. This position is heavily focused on occupational medicine and complex injury management, including catastrophic losses. The incumbent provides expert consultation on complex claims, emerging medical trends, treatment protocols, provider management strategies, and regulatory matters.

• Serve as a medical authority on occupational injuries and workers' compensation medical management.
• In conjunction with medical management peers, help establish and maintain evidence-based clinical guidance for treatment, recovery expectations, return-to-work planning, and disability duration management.
• Provide medical oversight and consultation on complex, severe, and catastrophic claims.
• Review and assess treatment plans, surgical recommendations, impairment ratings, causation questions, and medical necessity determinations.
• Support resolution of disputed medical issues and provide expert clinical opinions as needed.

• Provide direct consultation on a variety of claims, including complex/catastrophic claims, occupational disease exposures, and fatalities.
• Attend claims staffings, round tables and large loss review to provide medical perspective to claims management, discuss appropriateness of medical treatment and protocol, and provide prognosis to determine medical resources needed going forward.
• Partner with claims leadership to develop medical management strategies on high-severity losses.
• Evaluate long-term care projections, life care plans, Medicare Set-Asides, and future medical exposure estimates.

• Develop clinical programs designed to improve recovery outcomes and reduce disability durations where clinically appropriate.
• Promote early intervention strategies that support safe and sustainable return-to-work outcomes.
• Analyze medical trends and treatment patterns to identify opportunities for improved outcomes and medical cost management.
• Provide recommendations regarding emerging treatment protocols, pharmaceuticals, medical technologies, and healthcare delivery models.

• Collaborate with utilization review, claims management, network management and bill review partners.
• Evaluate provider performance and treatment outcomes based on identified standards, metrics, and file review.
• Support development of occupational health, specialty physician, and catastrophic injury provider networks. Consult with network development in the identification, recruitment, contracting and credentialing and monitoring of providers.
• Serve as senior sponsor for strategic medical vendor relationships.

• Lead and develop certain members of the Medical Management team, to include clinical staff, medical consultants, and related professionals as applicable.
• Foster a culture of collaboration, innovation, accountability, and continuous improvement.
• Mentor claims and operational leaders on medical trends, catastrophic injury management, and clinical best practices.

• Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) required.
• Board Certification in Occupational Medicine strongly preferred.
• Additional certification in Physical Medicine & Rehabilitation, Emergency Medicine, Orthopedic Surgery, Neurology, Trauma Surgery, or related specialty considered advantageous.

• Minimum 10 years of clinical experience, including at least 7 years…