Health Director remote jobs - 701 jobs

A leading diagnostics company is seeking a Board Certified Sign Out Director of Genetics. Responsible for interpretation of molecular genetic assays and implementing new assays. Candidates must have California Clinical Genetics Molecular Certification and a strong background in NGS. This role allows for remote work, making it a versatile option for qualified candidates. Join a vibrant team dedicated to quality assurance in genetic testing and contribute your expertise in a dynamic environment. #J-18808-Ljbffr

A tech company specializing in data streaming is seeking a Director, Technical Revenue and Assurance. The role involves leading the revenue policy framework and providing strategic advice on ASC 606 compliance. Candidates should possess at least 10 years of experience, strong leadership skills, and knowledge of US GAAP. The position is remote-friendly, ideal for those who thrive in a collaborative environment. Join a culture that values diverse perspectives and continuous improvement. #J-18808-Ljbffr

A leading global connectivity provider is seeking a Channel Sales Manager to enhance revenue growth through established partnerships. The ideal candidate will have 5-8 years in sales, focusing on channel sales management, and will be responsible for managing partner relationships to maximize sales effectiveness. Strong skills in Salesforce and a background in telecommunications or networking technology are required. This role offers competitive benefits including health care and a retirement plan. Remote work options are available. #J-18808-Ljbffr

Who We Are Point32Health is a leading not-for-profit health and well-being organization dedicated to delivering high-quality, affordable healthcare. Serving nearly 2 million members, Point32Health builds on the legacy of Harvard Pilgrim Health Care and Tufts Health Plan to provide access to care and empower healthier lives for everyone. Our culture revolves around being a community of care and having shared values that guide our behaviors and decisions. We've had a long-standing commitment to inclusion and equal healthcare access and outcomes, regardless of background; it's at the core of who we are. We value the rich mix of backgrounds, perspectives, and experiences of all of our colleagues, which helps us to provide service with empathy and better understand and meet the needs of the communities where we serve, live, and work. We enjoy the important work we do every day in service to our members, partners, colleagues and communities. Learn more about who we are at Point32Health. Job Summary Under the oversight of the Director, Behavioral Health, the Manager, Behavioral Health is responsible for leading at least one Behavioral Health functional team, managing team performance and results, and for managing the clinical processes that support the Behavioral Health department. The Manager, Behavioral Health is a member of the Behavioral Health leadership team; in addition to their own responsibilities the Manager assists in supporting and covering for other Behavioral Health leaders and participates in a variety of cross-functional Behavioral Health initiatives and processes. The Manager, in collaboration with the Director, is responsible for the development, implementation and maintenance of Behavioral Health initiatives and projects, as well as achievement of goals consistent with federal, state, and national requirements and regulations, and specific Tufts Health Plan initiatives and goals. The position is responsible for representing the Behavioral Health department on relevant internal and external work groups, implementation teams, and projects, for interfacing with divisional and enterprise teams, and for managing Behavioral Health accreditation compliance. Job Description Manage daily operations including, but not limited to, the assignment and distribution of work among assigned Behavioral Health Utilization Management team(s). Ensure all workflow processes are completed within the required timeframes and telephone coverage requirements are met. Ensure adherence to all department and regulatory standards. Serve as member of Behavioral Health leadership team. Provide back-up for peers, including supervisory coverage. Partner with peers to ensure effective cross-functional, end to end approach to meet the needs of members, providers, and internal and external stakeholders. Support and help drive efforts to integrate Behavioral Health into the broader Tufts Health landscape by providing a cohesive behavioral health presence and subject matter expertise to Public Plans and Enterprise activities including case management, medical management, and provider/network management. Under the direction of the Director of Behavioral Health, develop, implement and manage initiatives and projects to achieve Tufts Health Public Plans goals. Collaborate with internal departments in support of clinical activities and operations. Manager of Children's Behavioral Health Initiative (CBHI) team completes extensive network management activities in coordination with MassHealth and other MCOs/ACOs. Develop and prepare reports to meet internal, regulatory, contractual and accreditation requirements. Work closely with other departments in the development of report specifications and obtain data for and/or complete reports as needed to meet contract and regulatory requirements and track ongoing data. Hire, train, and manage staff. Supervise/coach staff to assist them in attaining optimal knowledge and job efficiency. Define metrics and goals for assigned team(s) and manage expectations. Utilize data to monitor and evaluate individual, team and program performance. Provide timely feedback to all staff regarding their performance via regular team and one-on-one meetings. Conduct formal performance appraisals. Take appropriate disciplinary action in a timely manner when needed. Ensure staff is provided with all necessary tools, resources and training to promote growth and performance within the department and/or organization. Monitor utilization management and ensure servicing goals are met or exceeded by tracking department metrics. Apply data, utilize evidence-based treatment practices and identify opportunities for improvement of quality of care and medical expense savings to design, implement and enhance utilization management and clinical care coordination processes. Track and monitor the impact of utilization management and care coordination on quality and medical expense measures. Complete monthly clinician case review audits and review semi-annual IRR results to monitor UM decision making and adherence to policies and procedures. Identify trends, develop and implement action plans for improvement progress Provide monthly Care Management report on team(s) performance, metrics, and goal achievement to the Director of Behavioral Health. Review and develop department policies, procedures, workflows and job aids as needed, consistent with departmental and company strategic objectives and mission. Develop, maintain, update orientation materials in collaboration with clinical trainer. Work collaboratively on and manage components of quality improvement initiatives and medical expense reduction activities and ensure alignment with broader company strategy. This includes activities that support NCQA accreditation and identify and promote best practices within clinical programs. Provide information and support to internal stakeholders. Work collaboratively with other managed care entities, MassHealth, the Executive Office of Health & Human Services, as well as provider and other stakeholder groups. Other duties and projects as assigned. Salary Range $98,659.20 -$147,988.80 Compensation & Total Rewards Overview The annual base salary range provided for this position represents a range of salaries for this role and similar roles across the organization. The actual salary for this position will be determined by several factors, including the scope and complexity of the role; the skills, education, training, credentials, and experience of the candidate; as well as internal equity. As part of our comprehensive total rewards program, colleagues are also eligible for variable pay. Eligibility for any bonus, commission, benefits, or any other form of compensation and benefits remains in the Company's sole discretion and may be modified at the Company's sole discretion, consistent with the law. Point32Health offers their Colleagues a competitive and comprehensive total rewards package which currently includes: Medical, dental and vision coverage Retirement plans Paid time off Employer-paid life and disability insurance with additional buy-up coverage options Tuition program Well-being benefits Full suite of benefits to support career development, individual & family health, and financial health For more details on our total rewards programs, visit *********************************************** We welcome all All applicants are welcome and will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status. Scam Alert: Point32Health has recently become aware of job posting scams where unauthorized individuals posing as Point32Health recruiters have placed job advertisements and reached out to potential candidates. These advertisements or individuals may ask the applicant to make a payment. Point32Health would never ask an applicant to make a payment related to a job application or job offer, or to pay for workplace equipment. If you have any concerns about the legitimacy of a job posting or recruiting contact, you may contact TA_****************************

Join the team leading the next evolution of virtual care. At Teladoc Health, you are empowered to bring your true self to work while helping millions of people live their healthiest lives. Here you will be part of a high-performance culture where colleagues embrace challenges, drive transformative solutions, and create opportunities for growth. Together, we're transforming how better health happens. Summary of Position Teladoc Health is seeking an experienced physician to serve as Medical Director, Cardiometabolic Clinical Care Model Design and Client Engagement. This physician leader will serve in a highly cross-functional role instrumental in shaping the future of cardiometabolic care at Teladoc Health, particularly within our U.S. Group Health Business, advancing clinical excellence across existing chronic condition management solutions while building and scaling novel approaches. This role will continue to champion seamless integration of cardiometabolic care across our expansive ecosystem of virtual primary care, urgent care, mental health, expert medical/specialty care, and more. This is an individual contributor leadership position requiring strong clinical expertise in cardiometabolic care and the ability to work strategically in the complex and rapidly evolving virtual care/digital health space. Success in this role requires close cross-functional collaboration with diverse stakeholders to enhance care delivery models, achieve best-in-class clinical outcomes, and optimize return on investment. The candidate will support value-based care partnerships and drive clinical research to strengthen the evidence base for virtual cardiometabolic care. Additionally, this physician leader must be able to translate these efforts into client-facing strategies, partnering with employers and payers to help them understand and achieve better health outcomes for their populations. Essential Duties and Responsibilities Serve as the clinical lead for designing cardiometabolic care models across new and existing capabilities within the U.S. Group Health business. Lead clinical and cross-functional teams to design, pilot, and scale innovative integrated cardiometabolic care models, working closely with front-line providers and care teams. Translate population health data and risk stratification into actionable program strategies. Define success metrics-including clinical outcomes and financial ROI-and develop strategies for sustained impact. Work closely with internal teams-including sales, marketing, and client-facing groups-providing clinical expertise for key presentations and client discussions. Represent the organization externally on topics related to chronic condition management and cardiometabolic care innovation. Develop and refine chronic condition management frameworks, measures, and reporting aligned with the Institute for Healthcare Improvement Quadruple Aim and Institute of Medicine quality domains: safety, effectiveness, patient-centeredness, efficiency, timeliness, and equity. Co-lead formal quality improvement projects using the Model for Improvement with a focus on process and outcome metrics and leveraging statistical process control (SPC) where appropriate. Partner with our Clinical Research team to generate evidence and insights for white papers and peer-reviewed publications demonstrating the impact of our cardiometabolic solutions. The time spent on each responsibility reflects an estimate and is subject to change dependent on business needs. Supervisory Responsibilities No Required Qualifications MD/DO in Internal Medicine, Family Medicine, or a cardiometabolic specialty; active medical license preferred At least 5+ years of post-residency or fellowship clinical experience Experience in virtual care, digital health, or healthcare technology, with the ability to adapt to rapid change and ambiguity. Demonstrated expertise in delivering evidence-based clinical care model design, clinical quality improvement, outcome measurement. Exemplary written and verbal communication skills, including the ability to explain complex clinical concepts to non-clinical audiences. Proven ability to collaborate effectively across clinical and non-clinical teams, including operations, product, engineering, marketing, commercial, and other functions in a highly matrixed environment. Strong prioritization, time management, and organizational skills, with meticulous attention to detail. Ability to thrive in fast-paced, dynamic environments with multiple competing priorities and deadlines. Preferred Qualifications Experience in dedicated virtual care/digital health organizations focused on cardiometabolic conditions. MBA/MPH and/or advanced quality improvement training preferred. Demonstrated experience delivering virtual care, particularly in primary care and cardiometabolic management beyond the COVID-19 pandemic. Expertise in value-based care delivery with track record of maximizing clinical outcomes while managing total cost of care. Required license or credential needed to perform job: MD/DO The above qualifications, knowledge, experience, and/or background are expected but not required for this role. Work Environment ☐ Office ☒ Remote ☐ Hybrid (Office & Remote) Travel: ≥10% Travel percentage reflects an estimate and is subject to change dependent on business needs. The base salary range for this position is $210,000 - $240,000. In addition to a base salary, this position is eligible for a performance bonus and benefits (subject to eligibility requirements) listed here: Teladoc Health Benefits 2026. Total compensation is based on several factors including, but not limited to, type of position, location, education level, work experience, and certifications. This information is applicable for all full-time positions. As part of our hiring process, we verify identity and credentials, conduct interviews (live or video), and screen for fraud or misrepresentation. Applicants who falsify information will be disqualified. Teladoc Health will not sponsor or transfer employment work visas for this position. Applicants must be currently authorized to work in the United States without the need for visa sponsorship now or in the future. Why join Teladoc Health? Teladoc Health is transforming how better health happens. Learn how when you join us in pursuit of our impactful mission. Chart your career path with meaningful opportunities that empower you to grow, lead, and make a difference. Join a multi-faceted community that celebrates each colleague's unique perspective and is focused on continually improving, each and every day. Contribute to an innovative culture where fresh ideas are valued as we increase access to care in new ways. Enjoy an inclusive benefits program centered around you and your family, with tailored programs that address your unique needs. Explore candidate resources with tips and tricks from Teladoc Health recruiters and learn more about our company culture by exploring #TeamTeladocHealth on LinkedIn. As an Equal Opportunity Employer, we never have and never will discriminate against any job candidate or employee due to age, race, religion, color, ethnicity, national origin, gender, gender identity/expression, sexual orientation, membership in an employee organization, medical condition, family history, genetic information, veteran status, marital status, parental status, or pregnancy). In our innovative and inclusive workplace, we prohibit discrimination and harassment of any kind. Teladoc Health respects your privacy and is committed to maintaining the confidentiality and security of your personal information. In furtherance of your employment relationship with Teladoc Health, we collect personal information responsibly and in accordance with applicable data privacy laws, including but not limited to, the California Consumer Privacy Act (CCPA). Personal information is defined as: Any information or set of information relating to you, including (a) all information that identifies you or could reasonably be used to identify you, and (b) all information that any applicable law treats as personal information. Teladoc Health's Notice of Privacy Practices for U.S. Employees' Personal information is available at this link .

At Caris, we understand that cancer is an ugly word-a word no one wants to hear, but one that connects us all. That's why we're not just transforming cancer care-we're changing lives. We introduced precision medicine to the world and built an industry around the idea that every patient deserves answers as unique as their DNA. Backed by cutting-edge molecular science and AI, we ask ourselves every day: “What would I do if this patient were my mom?” That question drives everything we do. But our mission doesn't stop with cancer. We're pushing the frontiers of medicine and leading a revolution in healthcare-driven by innovation, compassion, and purpose. Join us in our mission to improve the human condition across multiple diseases. If you're passionate about meaningful work and want to be part of something bigger than yourself, Caris is where your impact begins. Position Summary Caris is seeking a board-certified expert in Medical Oncology with deep experience in GI/GU malignancies to join our Medical Affairs team as Senior Medical Director, GI/GU. Reporting to the Senior Vice President of Medical Affairs and Chair of the Precision Oncology Alliance (POA), this individual will serve as a key strategic leader, scientific ambassador, and external face of Caris' precision oncology platform. The Senior Medical Director will blend clinical expertise, scientific credibility, and communication excellence to educate and inspire oncologists, researchers, and healthcare stakeholders worldwide-highlighting the transformative potential of Caris molecular. Job Responsibilities Serve as the senior clinical and scientific voice for Caris in GI/GU oncology, representing the company at national and international meetings, academic institutions, and major cancer centers. Deliver high-impact public and scientific presentations to clinicians, researchers, and thought leaders, translating complex genomic science into clear, clinically relevant insights. Cultivate and maintain strategic relationships with key opinion leaders (KOLs), clinical collaborators, and POA member institutions to advance the Caris mission and strengthen brand leadership in precision oncology. Partner with internal stakeholders across R&D, Medical Affairs, Commercial, Business Development, and Marketing to ensure clinical accuracy, alignment, and innovation in messaging and product positioning. Advise on clinical strategy and evidence generation to support Caris' growing presence in GI/GU oncology, including input on prospective trials, retrospective analyses, and real-world data initiatives. Contribute thought leadership to Caris' scientific communications-advisory boards, symposia, webinars, publications, and slide decks that convey Caris' scientific differentiation. Provide clinical mentorship to field-based medical personnel (e.g., Medical Science Liaisons), enhancing their effectiveness in customer engagement and scientific storytelling. Collaborate on content development for GI/GU oncology education programs, internal trainings, and professional/continuing medical education (CME) initiatives. Bridge insights from the field to internal teams, ensuring the evolving needs of GI/GU oncologists and researchers inform product innovation and R&D priorities. Required Qualifications MD or DO, board-certified in Medical Oncology (and/or Internal Medicine) with significant clinical experience in GI/GU oncology. Minimum of 3 years of recent clinical practice managing patients with solid tumors, with focused expertise in GI/GU malignancies. Proven excellence in scientific communication, public speaking, and KOL engagement at major oncology forums or academic settings. Demonstrated leadership in translating clinical and molecular insights into actionable strategies that advance product adoption or inform evidence generation. Strong executive presence, interpersonal skills, and ability to influence across scientific, clinical, and commercial domains. Proficient in Microsoft Office Suite, specifically Word, Excel, Outlook, and general working knowledge of Internet for business use. Preferred Qualifications Advanced understanding of molecular profiling, targeted therapies, and immunotherapy in GI/GU oncology. At least 3 years of experience in a senior Medical Affairs, Medical Director, or equivalent role within biotech, diagnostics, or pharmaceutical settings. Experience developing scientific education, publications, or clinical collaborations across multi-institutional networks. Established relationships with academic GI/GU oncologists and professional societies (IASLC, ASCO, ESMO, AACR, etc.). Physical Demands Must be comfortable with frequent travel (domestic and international), including evenings and weekends as required by business needs. Physical demands include typical office activities (sitting, using standard equipment, lifting routine office supplies). Training All job specific, safety, and compliance training are assigned based on the job functions associated with this employee. Annual Hiring Range $320,000 - $360,000 Actual compensation offer to candidate may vary from posted hiring range based upon geographic location, work experience, education, and/or skill level. The pay ratio between base pay and target incentive (if applicable) will be finalized at offer. Description of Benefits Highly competitive and inclusive medical, dental and vision coverage options Health Savings Account for medical expenses and dependent care expenses Flexible Spending Account to pay for certain out-of-pocket expenses Paid time off, including: vacation, sick time and holidays 401k match and Financial Planning tools LTD and STD insurance coverages, as well as voluntary benefit options Employee Assistance Program Pet Insurance Legal Assistance Tuition Assistance Conditions of Employment: Individual must successfully complete pre-employment process, which includes criminal background check, drug screening, credit check ( applicable for certain positions) and reference verification. This reflects management's assignment of essential functions. Nothing in this job description restricts management's right to assign or reassign duties and responsibilities to this job at any time. Caris Life Sciences is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender, gender identity, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified individual with disability.

The Medical Director, Radiation Oncologist is a key clinical leader responsible for managing and further developing the NantHealth, Inc. Eviti Solution, including oversight of the Medical Office professional staff of oncology nurse practitioners and radiation oncologists who conduct medical record and treatment plan review, systems input, and reporting to payer clients through the eviti | Connect platform. The Eviti Solution Medical Office functions to ensure that radiation oncology treatments comply with evidence-based medicine, nationally recognized best practices, and payer-defined standards of medical necessity, with the goal of supporting delivery of the highest-quality, most appropriate care to patients. This is a pivotal, national-impact role, with the Medical Director, Radiation Oncology serving as a key clinical interface between payer clients, treating physicians, and NantHealth clinical staff, while supporting day-to-day treatment plan review operations. The Medical Director, Radiation Oncology will serve as the primary clinical consultant for the eviti | Connect product, conducting peer-to-peer discussions with radiation oncology providers regarding patient treatment plans. The Director will be located within the continental United States or its territories when conducting peer-to-peer consultations. In addition to radiation oncology oversight, this role will play a key leadership role in oncology imaging utilization management. Responsibilities include the development, refinement, and ongoing maintenance of oncology imaging guidelines, as well as the creation of new tumor-specific and scenario-based imaging criteria. The Director will lead and participate in multidisciplinary oncology and imaging committees, ensure timely updates to imaging guidance as standards of care evolve, and integrate imaging decision-making with radiation treatment planning, disease stage, treatment intent, and line of therapy. This work is central to ensuring that oncology imaging guidance remains clinically nuanced, evidence-based, and aligned with modern oncology practice rather than siloed or purely radiology-driven. This is a full time, remote position, requiring availability to regularly work 40 hours per week, including holidays and weekends as necessary. Responsibilities include, but are not limited to: Oversee all aspects of radiation oncology treatment plan reviews performed by NantHealth Eviti radiation oncology consultants, oncology-certified nurses, and nurse practitioners, including integration of imaging considerations into treatment decision-making. Provide assurance to payer clients that radiation oncology and oncology imaging treatment plans are consistent with evidence-based care or represent medically justified deviations supported by clinical documentation. Further develop internal processes, workflows, and performance metrics to support a high-performing, disciplined approach to client service delivery, including consistent and timely reporting within established turnaround times. Ensure that radiation oncology and oncology imaging content within the Eviti regimen and guideline libraries is current, comprehensive, accurate, and reflective of evolving standards of care. Ensure that all clinical and utilization reporting is timely, accurate, and consistent with NantHealth Eviti-approved processes and quality standards. Lead peer-to-peer discussions with treating physicians in a highly professional, collaborative, and clinically credible manner, addressing both radiation treatment plans and associated oncology imaging decisions as appropriate. Collaborate with the NantHealth client management team and the Eviti Director of Clinical Operations to support and manage strategic relationships with client medical officers and senior clinical leadership. Execute programs, standards, and operational improvements that continue to enhance the capability, capacity, quality, and productivity of the NantHealth Eviti Medical Office and clinical staff. Provide ongoing education to NantHealth Eviti clinical staff on advances in radiation oncology and oncology imaging, including emerging technologies, evolving clinical indications, and guideline updates. Provide guidance and updates to NantHealth Eviti clinical staff and Development teams regarding billing, coding, and reimbursement considerations for radiation oncology and oncology imaging services. Participate in quality assurance, performance improvement, and internal educational initiatives, including review of clinical outcomes, guideline adherence, and peer review activities. Maintain continuous self-education and expand expertise in high-quality, cost-effective radiation oncology and oncology imaging practices. Serve as a thought leader in evidence-based radiation oncology and oncology imaging, proactively contributing to clinical leadership, guideline development, and professional discourse within the oncology community. Education & Experience Requirements: Possess a Current Active Unrestricted Physician License in the United States or its territories Board Certification in Radiation Oncology A minimum of 5 years of oncology practice experience in a community or academic setting with an acute understanding of day-to-day cancer care Proven clinical leadership experience, with a record of scholarly activity, publications, or involvement in guideline development preferred. Strong understanding of radiation oncology practice and the healthcare insurance landscape, including medical necessity, utilization management, and payer policy considerations for related conditions. Excellent organizational skills with strong attention to detail and the ability to manage multiple priorities effectively. Required Knowledge, Skills, and Abilities: Outstanding interpersonal and collaborative skills, with the ability to engage effectively with physicians, clinical staff, medical management, and cross-functional teams. High level of computer proficiency, including Microsoft Word, Excel (data creation and analysis), and PowerPoint; comfort working within clinical decision-support platforms. Familiarity with relational database concepts and clinical data systems preferred but not required. Strong numerical aptitude and understanding of basic statistical concepts, with the ability to interpret and apply data to clinical decision-making. Excellent oral and written communication skills, with well-developed analytical and problem-solving abilities. Decisive, proactive, and adaptable, with a hands-on mindset and a willingness to engage directly in problem resolution. Ability to thrive in a fast-paced, rapidly evolving environment, balancing strategic thinking with practical execution. Demonstrated ability to build and maintain professional relationships across industry, physician networks, academia, and governmental or regulatory entities. Highly motivated, energetic, and passionate about improving the quality, value, and integrity of autoimmune care. Unwavering commitment to ethical conduct, scientific rigor, and professional integrity. Possess a strategic mindset while also demonstrating the ability to manage the operational and tactical aspects of the role Demonstrate superior written and verbal communication and presentation skills Demonstrate the ability to apply sound clinical judgment in complex or ambiguous cases where evidence, guidelines, and payer policy may not fully align Exhibit natural gravitas, credibility, and the ability to influence clinical and non-clinical stakeholders Be approachable, collegial, easy to engage, and demonstrate intellectual curiosity Have the ability to lead and manage staff in remote and distributed environments Be technologically adept, comfortable working with software platforms and clinical decision-support tools Be a strong problem solver, able to quickly identify issues, consider multiple perspectives, and navigate complex or difficult situations diplomatically Be proactive, well organized, and highly reliable in managing responsibilities Understand the intersection of clinical care, payer policy, medical necessity, and regulatory requirements, and communicate effectively across those domains The salary for applicable US-based applicants to this position is below. The specific rate will depend on the successful candidate's qualifications, prior experience as well as geographic location. $340,000 base salary plus bonus potential.

The Physical Health Medical Director plays a key role within the Physical Health Medical Management Team, providing clinical oversight, medical expertise, and operational support for physical health services. This position ensures high quality, evidence based medical review processes and supports organizational goals related to clinical quality, utilization management, and care coordination. This position will allow the successful candidate to work primarily remote. While there is no expectation to be in the office routinely, the selected candidate may be required to report on-site as needed. It's strongly preferred that the selected candidate reside in North Carolina or be willing to relocate. This position may be required to work weekends and holidays based on organizational and operational requirements. Responsibilities & Duties Clinical Oversight & Medical Review Provide expert guidance and oversight for physical health service requests, including authorization of services and determination of appropriate level of care Ensure the integrity and quality of utilization management activities, including initial reviews, concurrent reviews, appeals, and level of care determinations for inpatient and outpatient services Participate in internal reviews of inpatient and outpatient clinical case types to ensure compliance with regulatory, accreditation, and organizational standards Review Approval and Denial of Service and Level of Care Requests Apply medical necessity criteria utilizing review criteria hierarchy for level of care and services regarding type, amount, and duration of service. Complete expected case volume as expected by the department Process Adherence, Quality & Efficiency Follow department processes-as defined by approved Alliance policies, desk procedures, and workflows referenced on the Alliance Grid and in the Medical Director OneNote-to complete timely utilization reviews in Alliance's UM platform and perform tasks efficiently Apply established workflows and maintain quality case reviews to ensure consistent decision making, documentation accuracy, and adherence to regulatory compliance Operational & Committee Support Support the Clinical Operations Department through active participation in organizational committees, including but not limited to Clinical Quality Review, Transition of Care Rounds, Overturn Committee Provide clinical guidance and leadership to promote collaboration between medical, behavioral, and care management teams External Engagement Participate in mediation activities and Office of Administrative Hearing (OAH) processes as required, providing clinical expertise and documentation support Additional Responsibilities Maintain awareness of regulatory requirements, utilization management guidelines, and emerging trends affecting utilization management and physical health services Contribute to process improvement initiatives aimed at enhancing clinical quality, efficiency, and member outcomes Support cross functional teams with medical expertise, as needed Provide consultation, training, and education to staff and community partners on relevant topics as needed Train and mentor peers within the Medical Management team and assist with onboarding PH Medical Director new hires as needed Maintain a Positive Environment Work with Human Resources and Medical Team to attract, maintain, and retain a highly qualified and well-trained workforce Actively establish and promote a positive, diverse, and inclusive working environment that builds trust with teammates Ensure all staff are treated with respect and dignity Ensure standards are transparent and applied consistently, impartially, and ethically over time and across all staff members Minimum Requirements Education & Experience Graduation from an accredited Medical School. M.D./D.O. degree is required and board certification in a relevant field. At least four (4) years of postgraduate clinical experience and two (2) or more years of managed care and utilization management experience are required. Special Requirement Current, active, and unrestricted license to practice medicine in North Carolina or meets qualifications to obtain a North Carolina Medical License with Board certification for appropriate field of Medicine (American Board of Family Medicine or American Board of Internal Medicine). Knowledge, Skills, & Abilities Knowledge of the information and techniques needed for diagnosis and treatment of medical issues, including symptoms, treatment alternatives, drug properties and interactions, and preventive health-care measures Knowledge of Managed Care Principles Knowledge of recent developments in the field of medicine Microsoft Office Skills Ability to speak with colleagues about treatment concerns, complex case issues and best practice recommendations Utilization Management experience Salary Range $211,172 - $269,245/Annually Exact compensation will be determined based on the candidate's education, experience, external market data and consideration of internal equity An excellent fringe benefit package accompanies the salary, which includes: Medical, Dental, Vision, Life, Long Term Disability Generous retirement savings plan Flexible work schedules including hybrid/remote options Paid time off including vacation, sick leave, holiday, management leave Dress flexibility

The Regional Medical Affairs Director (RMAD) is a member of a field-based team which is an extension of the US Regional Medical Affairs organization and is responsible for developing and enhancing professional relationships with specified key thought-leaders (KTLs), institutions, and organizations in their assigned geographical region. A RMAD focuses on medical & scientific engagement with identified healthcare and decision maker stakeholders by providing medical and scientific support via scientific exchange, addressing customers medical and scientific informational needs, and collaborating in mutually identified areas of medical, education, clinical research, and real-world experience/evidence. RMADs are recognized as an internal subject matter expert and provide appropriate medical and scientific support for internal teams as identified. Candidate to reside in: Houston, TX; San Antonio, TX; New Orleans, LA; or Jackson, MS Territory covers: TX, LA, MS Responsibilities Fostering mutually collaborative relationships with institutions, Centers of Excellence, thought leaders (TLs) and key decision makers across the healthcare ecosystem in the areas of medical, education, clinical research, and real world experience. Provide medical information through scientific exchange in a fair-balanced manner and clinical/scientific support as identified or requested in addressing the informational needs of the healthcare community, as well as responding to unsolicited requests for pipeline or off-label information. Delivering medical presentations to diverse healthcare professional (HCP) audiences including healthcare decision makers, professional medical societies, and identified advocacy groups. Providing scientific and liaison support related to Xeris clinical research activity, including thought leader and investigator engagement and follow-up, and facilitation of unsolicited requests for interactions related to Investigator Initiated Studies (IISs). Maintaining cross-functional collaboration with internal & external field teams to provide scientific expertise and medical support within Medical Affairs, Clinical Development, Commercial, and other internal stakeholders, etc. Obtaining, assimilating, organizing, and reporting appropriate competitive and scientific intelligence in a concise, clear manner, compliant with all applicable Xeris policies, procedures, and processes Attending & participating in medical/scientific meetings and conferences for the purpose of gaining scientific insights, collecting emerging scientific data, identifying healthcare trends, and supporting the scientific exchange and communication related to Xeris therapeutic areas of interest and research & development As identified, contribute to internal training for headquarter- and field-based teams and supporting speaker training initiatives. Assisting with the implementation and engagement of TL participation in advisory boards, consultant meetings and other scientific meetings consistent with all Xeris policies, procedures, and processes. Maintain clinical/scientific expertise and providing strategic insights into emerging scientific data and healthcare trends. Collaborating with TLs and Xeris Medical Communications to support the development of appropriate publications and related medical communications. Participate in assigned Medical Affairs projects, initiatives, and activities as identified and requested. Performing and completing administrative responsibilities, including reporting requirements in a timely fashion Qualifications Advanced degree (MD, PhD, PharmD, DNP) in a related discipline strongly preferred Less than 2 years of experience [Entry level as Associate Director]; 2+ years of experience [Entry Level as Director] of previous Field Medical or Medical Affairs pharmaceutical industry [post-doctoral pharmaceutical industry training via residency or fellowship also welcomed] Active clinical care, clinical research, or academia experience preferred Clear understanding of regional medical practice, clinical decision-making and healthcare systems affecting patient care. Demonstrated strong understanding of clinical research trial and/or related laboratory research design and execution Extensive knowledge of Endocrinology, including Cushing's Disease and field medical affairs is strongly preferred. Competencies: Customer Service focus, Teamwork & Collaboration, Written and Verbal Communication skills, Presentation skills, Time Management skills, Self-Starter. Working Conditions: Position may require periodic evening and weekend work, as necessary to fulfill obligations. Periodic overnight travel. Approximately 60% overnight travel The level of the position will be determined based on the selected candidate's qualifications and experience. #LI-REMOTE As an equal employment opportunity and affirmative action employer, Xeris Pharmaceuticals, Inc. does not discriminate on the basis of race, color, religion, sex, gender identity, sexual orientation, national origin, age, disability, veteran status, genetics or any other characteristic protected by law. It is our intention that all qualified applications are given equal opportunity and that selection decisions be based on job-related factors. The anticipated base salary range for this position is $170,000 to $225,000. Final determination of base salary offered will depend on several factors relevant to the position, including but not limited to candidate skills, experience, education, market location, and business need. This role will include eligibility for bonus and equity. The total compensation package will also include additional elements such as multiple paid time off benefits, various health insurance options, retirement benefits and more. Details about these and other offerings will be provided at the time a conditional offer of employment is made. Candidates are always welcome to inquire about our compensation and benefits package during the interview process. NOTE: This job description is not intended to be all-inclusive. Employee may perform other related duties as negotiated to meet the ongoing needs of the organization. Direct Employers Posting: Houston, TX; New Orleans, LA; Jackson, MS.

If you are a current associate, you will need to apply through our internal career site. Please log into Workday and click on the Jobs Hub app or search for Browse Jobs. BluePearl is seeking an experienced, motivating, and driven clinical leader to join our team as a Group Medical Director - East Division. This is a remote position overseeing multiple hospital locations, with up to 60% overnight travel required. The Group Medical Director (GMD) has medical oversight of multiple markets within the organization with combined revenues of up to $150MM. The incumbent has the ultimate responsibility for translation of organizational objectives into market-specific objectives that instill a clinician-driven culture, promote clinician engagement and retention, and yield strong fiscal performance. A GMD frequently travels to hospitals to evaluate and mentor medical leaders and address concerns. The role partners with other members of the field leadership team to ensure a balanced representation of medical quality and financial considerations and the people & organization department to champion consistency in a high performance and engaged workforce united in being BluePearl. As a GMD, you will: Identify, oversee and develop medical leaders (Medical Directors and their ER Service Team Leads) to ensure optimal clinician productivity and engagement. Responsible for creating a clinician-driven culture in assigned markets. Serve as high-level representative and champion of BluePearl mission and vision in all interactions within the organization and external veterinary community. Partner with field leaders to effectively communicate and cascade key initiatives impacting medical staff. Foster a collaborative and trusting relationship between the support team and hospitals. Partner with field leaders to ensure appropriate productivity levels and growth plans for clinicians and hospitals, including maximizing technical teams. Monitor reports on operating costs within functional areas. Alerts hospital leaders of cost and labor over run. Partners with field leaders, finance and P&O to assess concerns and implement solutions. Own the success of on-site visit process for DVM candidates in assigned markets, ensures onboarding and mentoring of new BluePearl Clinicians through BluePearl Mentorship Program. Ensure standards for medical quality, patient safety reporting, equipment, and clinician productivity/performance are met. Partner with assigned Vet Relations team to collaborate on pDVM referral strategies that impact assigned markets. Oversee and encourage support of continuing education programs across assigned markets and ensures programs sufficiently develop and engage technicians and clinicians to deliver remarkable care to patients. Monitor reports on medical occurrences, patient safety and client experience and partners with stakeholders as needed to ensure swift resolution, improvements, and/or coaching as needed. Work collaboratively with the BluePearl Support Team to develop solutions for escalated concerns and influences medical leaders to shape adoption and ensure effectiveness of resolutions. Travel around 50% to ensure in-person leadership and mentoring in hospitals. EDUCATION/EXPERIENCE Bachelor's Degree and DVM (Doctor of Veterinary Medicine) required. Completion of 1-year rotating internship required. May be Emergency Clinician or board-certified Specialty Clinician. 7+ years of leadership experience required (previously overseeing multiple sites or revenues exceeding $25MM preferred.) Why BluePearl? Our passion is pets. We offer Trupanion pet insurance and discounts to our associates for pet treatments, procedures, and food. We encourage you to grow with us. Our technicians are leveled by their skillset and move up in level as they gain more skills and experience. We are focused on developing our associates into leaders through talent development programs and leadership workshops. As a member of Mars Veterinary Health, our associates have endless opportunities to advance in his/her career. In order to transform and lead the industry through innovative quality medicine and care, we understand the importance of continuous learning. We offer annual continuing education allowance, free continuing education sessions, our own BluePearl University for training, and our clinicians have access to over 2,000 medical journals. We value your health and well-being as an associate by providing you with the following: Health, dental, vision, and life insurance options. Annual company store allowance. Flexible work schedules. Time to reset, rewind, and reflect through our paid time off, paid parental leave, and floating holiday plans. A regional licensed social worker who can provide guidance, advice, and tips/tricks on how to maintain a healthy lifestyle while working in a fast-paced emergency and specialty care environment. We promote a family-like culture in our hospitals. We are all in this together. We believe in working together to lead the industry by enriching lives through remarkable care for pets BluePearl is committed to a diverse work environment in which all individuals are treated with respect and dignity. We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, creed, sex, age, disability, genetic information, marital status, citizenship status, sexual orientation or affectional preference, or gender identity or expression, protected veteran status, or any other characteristic protected by law. If you need assistance or an accommodation during the application process because of a disability, it is available upon request. The company is pleased to provide such assistance, and no applicant will be penalized as a result of such a request. We are an Equal Opportunity Employer and a Drug Free Workplace.

The Behavioral Health Medical Director is responsible for the overall safety of patients with a BH diagnosis, with a special focus on safe prescribing. Essential Functions: Assume responsibility for the overall safety of patients with a BH diagnosis, with a special focus on safe prescribing Serve as the clinical lead in developing and implementing evidenced based clinical policies and practices Participate in regulatory/accreditation reviews Assume key role in quality improvement initiatives, case management activities and member safety activities (i.e. incident management) BH coverage determination for utilization management to ensure members receive appropriate and medically necessary care in the most cost-effective setting Oversight and quality improvement activities associated with case management activities Provide guidance to BH orientation and network development/ recruitment in conjunction with provider relations, value-based contracting, support of episodes of care and full integration of BH services Assist in the review of utilization data to identify variances in patterns, and provide feedback and education to MCP staff and providers as appropriate Represent CareSource as the primary clinical liaison to members, providers and State agencies Support of regulatory and accreditation functions (e.g. CMS, State, NCQA and URAC) and compliance for all programs Participate in the development, implementation and revision of the clinical care standards and practice guidelines ensuring compliance with nationally accepted quality standards Participate in the development, implementation and revision of the Quality Improvement Plan and corporate level quality initiatives Collaborate with market/product leaders to help define market strategy Community collaborative participation Participate in the evaluation and investigations of cases suspected of fraud, abuse, and quality of care concerns Provide cross-coverage for other Medical Directors and/or markets, as needed Support staff by providing training, clinical consultation, and clinical case review for members including Medical Advisement meetings Perform any other job duties as requested Education and Experience: Completion of an accredited Medical Degree program as a medical doctor (MD) or Doctor of Osteopathic (DO) medicine is required Successful completion of a residency training program in psychiatry is required Minimum of three (3) years of clinical practice experience is required Experience in safe prescribing is required Managed care medical review/medical director experience is preferred Competencies, Knowledge and Skills: Basic Microsoft Word skills Excellent communication skills, both written and oral Ability to work well independently and within a team environment Ability to create strong relationships with Providers and Members Previous Institute for Healthcare Improvement (IHI) or equivalent training participation is preferred High ethical standards Attention to detail Critical listening and systematic thinking skills Ability to maintain confidentiality and act in the company's best interest Ability to act with diplomacy and sensitivity to cultural diversity Decision making/problem solving skills Conflict resolution skills Strong sense of mission and commitment of time, effort and resources to the betterment of the communities served Ability to analyze healthcare data from a variety of sources to evaluate physician practice patterns Leadership experience and skills Licensure and Certification: Current, unrestricted license to practice medicine in state of practice as necessary to meet regulatory requirements is required Board Certification in Psychiatry is required Re-certification, as required by specialty board, must be maintained MCG Certification is required or must be obtained within six (6) months of hire Working Conditions: General office environment; may be required to sit or stand for extended periods of time May be required to work evenings/weekends May be required to travel in-state to fulfill duties of position Compensation Range: $195,200.00 - $341,600.00 CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package. Compensation Type (hourly/salary): Salary Organization Level Competencies Fostering a Collaborative Workplace Culture Cultivate Partnerships Develop Self and Others Drive Execution Influence Others Pursue Personal Excellence Understand the Business This is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.#LI-SW2

HJ Staffing is urgently seeking a Medical Director of Utilization Management to join a leading Medicare Advantage Health Plan. This physician leader will play a critical role in ensuring the clinical integrity of inpatient and post-acute care reviews, evaluating medical necessity to support optimal outcomes and regulatory compliance. Location: 100% Remote Schedule: Full-Time, Monday - Friday (Must work PST hours) Job Description Reporting to the Chief Medical Officer, the Medical Director focuses on Evaluating hospital admissions, continued stays, and post-acute services for Medicare Advantage members. You will guide timely care determinations using CMS regulations and evidence-based practices (MCG/InterQual) while collaborating with care management teams and external providers. What You Will Do Clinical Review: Conduct timely medical necessity determinations for inpatient admissions and post-acute settings (SNF, IRF, LTACH, and Home Health). Criteria Application: Use evidence-based guidelines (MCG/InterQual) and CMS criteria to assess the appropriateness of acute care services. Peer-to-Peer: Lead discussions with attending physicians to clarify clinical documentation and support appropriate levels of care. Complex Case Management: Serve as the primary physician reviewer for escalated or complex UM cases requiring expert medical judgment. Collaboration: Partner with utilization and care management teams to ensure consistent, cost-effective care and participate in UM committee meetings. Compliance & Documentation: Ensure all decisions are documented according to NCQA and CMS requirements; support audit preparedness and delegated oversight. Utilization Trends: Identify patterns in care and support interventions to reduce unnecessary admissions or extended stays. What You Will Bring Credentials: Licensed M.D. or D.O. in good standing in your state of residence. Clinical Experience: Minimum of 5 years of clinical experience. Managed Care Expertise: At least 3 years in a utilization management or medical leadership role within a managed care or health plan setting. Specialized Knowledge: Strong experience in inpatient/post-acute case review and deep knowledge of Medicare Advantage regulations and CMS coverage criteria. Technical Skills: Extensive experience with MCG guidelines and advanced proficiency in MS Office and medical management software. Education (Preferred): MPH, MBA, or MHA; Certification by the American Board of Quality Assurance and Utilization Review Physicians (ABQAURP). You Will Be Successful If: You are an expert in using data to design and implement clinical programs and population health management. You possess strong negotiation skills, particularly in physician-to-physician interactions. You thrive in a matrix organization and can mentor staff while making independent, high-stakes decisions. You have a meticulous eye for detail and can maintain a reasonable rate of speed in a fast-paced, high-volume environment. You are committed to the highest standards of confidentiality and clinical documentation.

Required licensure: TX, KY, FL, WA licenses are preferred The Behavioral Health Physician will serve as an independent contractor providing physician-level utilization management (UM) services for behavioral health services. This role is non-clinical and limited exclusively to medical necessity determinations, peer-to-peer reviews, and appeals in accordance with applicable regulations, accreditation standards, and plan policies. Scope of Services The Contractor will perform UM activities including, but not limited to: Initial Medical Necessity Reviews for behavioral health services requiring physician-level determination Concurrent Reviews for continued authorization of services Peer-to-Peer (P2P) Reviews with treating providers Appeals Reviews, including first- and second-level determinations, as applicable Issuance of adverse determinations when clinically indicated, ensuring compliance with federal and state regulations, parity requirements, and plan policies Documentation of determinations in UM systems with clear clinical rationale and supporting criteria Participation in quality improvement processes related to UM decisions, as requested Exclusions / Non-Scope This role does not include: Direct patient care or treatment Prescribing services Care coordination or case management Administrative leadership or supervisory responsibilities Clinical Expertise & Requirements MD or DO with board certification in Psychiatry (required) Active, unrestricted medical license in applicable state(s) of review Experience in behavioral health utilization management, preferably in managed care or health plan settings Demonstrated knowledge of: Medical necessity criteria (e.G., MCG, InterQual, or equivalent) Federal and state behavioral health regulations MHPAEA requirements NCQA and CMS standards Strong peer-to-peer communication skills Work Expectations Remote work environment Flexible scheduling based on case volume and turnaround time requirements Ability to meet required regulatory and contractual decision timelines Maintain confidentiality and comply with HIPAA and data security standards Reporting & Oversight Operates independently while adhering to health plan UM policies, delegated authority parameters, and medical policy Subject to audit, quality oversight, and performance monitoring consistent with UM regulatory requirements

Site: Mass General Brigham Incorporated Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham. Job Summary Mass General Brigham Health Plan UM Medical Director Qualifications Education: MD or DO required Licenses and Credentials: * Physician - Massachusetts active full license required Experience: * 5+ years of Health Plan UM experience * at least 5 years of clinical practice experience Knowledge, Skills and Abilities: * Utilization Management experience * Excellent written and oral communications skills * Proficient in basic computer skills, use of EHR's, digital tools * Multitasking abilities * Adaptable to change due to business growth Job Description: * Handles utilization management initial determinations, appeals and grievances within the scope of their expertise as defined by Medicare, MassHealth, NCQA and the Division of Insurance and within the compliance requirements of key regulatory and accreditation entities * Use CMS, state and internal medical necessity policies to guide MN determinations * Complete peer to peer case discussions with requesting providers as assigned * Refer to IRO/external review if specialist match or expertise is needed * Interact, communicate and collaborate with network and community physicians, hospital leaders and other vendors regarding care and services for enrollees * Monitors performance metrics to identify areas for continuous improvement and ensure compliance * Establishes and maintains positive relationships with colleagues and customers and gains their trust and respect * Ensure diversity, equity and inclusion are integrated as a guiding principle Other duties as assigned with or without accommodation Additional Job Details (if applicable) * Primarily remote position * M-F 830-5pm EST * Ensures that all assigned work is completed within regulatory timelines * Checks and addresses assigned work queues, email, Teams messages during assigned work hours Remote Type Remote Work Location 399 Revolution Drive Scheduled Weekly Hours 0 Employee Type Regular Work Shift Day (United States of America) EEO Statement: Balance Sheet Cost Centers is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veteran's Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants who require accommodation in the job application process may contact Human Resources at **************. Mass General Brigham Competency Framework At Mass General Brigham, our competency framework defines what effective leadership "looks like" by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.

Job DescriptionMEDICAL DIRECTOR - REMOTE ARC Group has an immediate opportunity for a Medical Director! This position is 100% remote working eastern time zone business hours. This is a direct hire FTE position and a fantastic opportunity to join a well-respected organization and have a positive impact on the lives of millions of people. At ARC Group, we are committed to fostering a diverse and inclusive workplace where everyone feels valued and respected. We believe that diverse perspectives lead to better innovation and problem-solving. As an organization, we embrace diversity in all its forms and encourage individuals from underrepresented groups to apply. 100% REMOTE! Candidates must currently have PERMANENT US work authorization. Sorry, but we are not considering any candidates from outside companies for this position (no C2C, 3rd party / brokering). SUMMARY STATEMENT The Medicare Contractor Medical Director (CMD) provides medical leadership and decision making for an organization that serves as a Medicare Administrative Contractor (MAC). This role serves as a liaison between the Centers for Medicare and Medicaid Services (CMS) and stakeholders. CMDs play a vital role in developing Local Coverage Determinations (LCDs) and ensuring compliance with Medicare policies, reviewing medical claims, and promoting evidence-based healthcare. ESSENTIAL DUTIES & RESPONSIBILITIES Clinical Expertise and Consultation 30% Provide leadership in clinical program outreach to the practitioner/provider/supplier/beneficiary community. Provide direction and assistance to clinical staff in conducting provider education, as well as assist in the development of clinical guidelines as needed. Keep clinical knowledge up to date and abreast of medical practice and technology changes. Serve as a subject matter expert in medical and clinical areas relevant to the Medicare program. Provide clinical consultation to internal teams (e.g., medical review staff, appeals teams) and external stakeholders. Provide the clinical expertise, scientific literature analysis, claims data analytics to effectively focus medical polical policy and reviews on identified problem areas. Collaboration and Leadership 30% Collaborate with CMS and other Medicare Contractors (e.g., A/B or DME MACs and others) to develop and update medical policies and articles based on clinical evidence and regulatory requirements. Work with multidisciplinary teams within the MAC to improve processes and ensure compliance with CMS directives. Liaise with CMS staff, medical societies, and other stakeholders to align goals and address emerging issues. Represent the MAC at CMS meetings and industry conferences. Strengthen the quality improvement procedures with emphasis on decision consistency and clinical education of clinical staff through various mechanisms including but not limited to overseeing Inter-Reviewer Reliability (IRR) reviews. Program Integrity 20% Support program integrity initiatives, including identifying trends in inappropriate billing practices or noncompliance. Ensure the proper application of Medicare regulations, national and local coverage determinations (NCDs and LCDs), and clinical guidelines. Participate in all phases of LCD development by leading the Local Coverage Determination (LCD) process to include development, revision, retirement, education, and decision making. Collaborate with investigative teams and law enforcement when required. Medical Review (MR) and Appeals 10% Oversee medical review activities to ensure appropriate and consistent decisions on claim determinations including pre- and post-payment determinations. Provide leadership in developing and implementing MR Quality Assurance Programs. Provide leadership in effectively focusing MR and developing internal MR guidelines. Review complex or high-level appeals and provide guidance on the application of Medicare policies. Provide support to the claim appeal process including assistance in the development of position papers and participation in the administrative process when needed such as Administrative Law Judge (ALJ) hearings. Provider Education and Communication 10% Provide leadership in the provider community (including interacting with hospital/specialty associations). Educate providers, individually or as a group, regarding identified problems or medical policy. Maintain Professional and Organization Relationships Performs other duties as the supervisor may, from time to time, deem necessary. Travel within and outside the assignedjurisdictions, as needed. Expected to be no more than 3-4 weeks/year but could vary based on business needs. REQUIRED QUALIFICATIONS MD or DO degree from accredited Medical School Minimum of three years clinical practice experience as an attending physician Extensive knowledge of the Medicare program, particularly the coverage and payment rules Work experience in the health insurance industry, a utilization review firm, or another health care claims processing organization in a role that involved developing coverage or medical necessity policies and guidelines. Knowledge, skill, and experience to evaluate clinical evidence, and to develop evidence-based medical necessity standards within the Medicare fee-for-service benefit structure Ability to develop strategies and processes to ensure evidence-based decision-making for policy in the Medicare population Basic understanding of medical coding conventions Ability to effectively communicate, collaborate with, and provide education on health care policy issues to both internal team members and external entities Ability to work collaboratively with internal staff to evaluate aberrancies, determine appropriate billing, coding, pricing, and utilization of services Proficiency with effective public speaking and ability educate providers Ability to work collaboratively with clinical and non-clinical team members Ability and desire to educate team members and external entities (i.e., CMS, providers, other federal agencies, law enforcement, etc.) Computer literacy, including proficiency using word processing, spreadsheets, presentation, and virtual meeting applications Ability to complete independent or computer-based training and education Certifications, Licenses, Registration: Current, active, valid, unrestricted license to practice medicine in at least one state or territory within the United States, never suspended or revoked in any state or territory of the United States Eligible for licensure within jurisdiction of enterpriseoperations Board Certified Doctor of Medicine or a Doctor of Osteopathy in a specialty recognized by the American Board of Medical Specialties for at least three years PREFERRED QUALIFICATIONS Experienced Physical Medicine and Rehabilitation (PM&R), Oncology, Radiology, Ophthalmology or Infectious Diseases professionals with five years of clinical practice MBA, MHA, MS in Management, or formal accredited coursework in medical systems management Demonstrated successful working experience in organized medicine group(s) (e.g., AMA, specialty society, state health department) as a committee chairperson or other leadership Medical Director experience in Medicare-related or commercial healthcare organization Coding and billing experience utilizing HCPCs, CPT, and ICD-10 codes Experience using GRADE methodology for literature analysis and performing systematic reviews Experience working with physician groups, beneficiary organizations, and/or congressional offices Would you like to know more about our new opportunity? For immediate consideration, please send your resume directly to John Burke at ******************** or apply online while viewing all of our open positions at ******************* ARC Group is a Forbes-ranked a top 20 recruiting and executive search firm working with clients nationwide to recruit the highest quality technical resources. We have achieved this by understanding both our candidate's and client's needs and goals and serving both with integrity and a shared desire to succeed. At ARC Group, we are committed to providing equal employment opportunities and fostering an inclusive work environment. We encourage applications from all qualified individuals regardless of race, ethnicity, religion, gender identity, sexual orientation, age, disability, or any other protected status. If you require accommodations during the recruitment process, please let us know. Position is offered with no fee to candidate.

Join Martin's Point Health Care - an innovative, not-for-profit health care organization offering care and coverage to the people of Maine and beyond. As a joined force of "people caring for people," Martin's Point employees are on a mission to transform our health care system while creating a healthier community. Martin's Point employees enjoy an organizational culture of trust and respect, where our values - taking care of ourselves and others, continuous learning, helping each other, and having fun - are brought to life every day. Join us and find out for yourself why Martin's Point has been certified as a "Great Place to Work" since 2015. Position Summary The Medical Director (MD) provides clinical leadership and direction to the utilization & care management functions of Martin's Point's Health Plans. The MD works collaboratively with other plan functions that interface with Medical Management such as Health Management, Compliance and Appeals, , Network Management, Member Services, benefits & claims management, and Compliance. In this role, there is the opportunity to assist in or drive short and long-range clinical programming, quality management, and external relationships. The Medical Director reports to the Vice President Health Plan Medical Director and works closely with the other Health Plan leaders. Job Description Key Outcomes: Responsible and accountable to the Health Plan Medical Director for helping to manage health plan medical costs by assuring clinically appropriate health care delivery for health plan products and services utilizing Evidence-Based Guidelines to ensure the right service at the right time and place for each member Performs medical necessity reviews of requests for health plan-covered services (benefits). Reviews disputes and appeals of said services for clinical appropriateness and in compliance with government program rules Contributes to case reviews to ensure the quality and safety of care and services delivered to Martin's Point Health Plan members. Assists in the construction of the annual Utilization Management, Care Management, and Disease Management Program Descriptions and works to ensure the programs meet accreditation and regulatory standards (e.g. NCQA, CMS, TRICARE) Participates in medical policy review and policy development. Works with Informatics, Network Management, and Medical Economics to create and maintain a system where Network providers are properly assessed in regard to cost management and develops a plan and schedule for communication and solutioning with outliers. Develops an in-depth understanding of ACOs and contributes to their management and strategic deployment. Provides support to Health Plan risk adjustment activities as needed. Is conversant with Health Plan key performance metrics, in particular utilization and cost management goals, MLR , inpatient days/1000, SNF days/1000, and clinical quality improvement (QI) objectives, including HEDIS and how to drive improvement in these areas Education/Experience: Board certified physician with post-graduate experience in direct patient care required Medical leadership in, or focused activity of, a Health Plan (preferred) Knowledge of process improvement tools Experience in Health Plan utilization management Experience in Medicare Advantage and/or TriCare preferred Required License(s) and/or Certification(s): Active and unrestricted license to practice medicine in Maine or New Hampshire; or another U.S. state with eligibility to apply for and obtain additional state licensure. Current, or ability to have some, active clinical work with patients Skills/Knowledge/Competencies (Behaviors): Deep knowledge and practical understanding of Health Care systems and Managed Care concepts Knowledge and deep commitment to performance-based Health Plan systems Good analytic skills with the ability to identify meaningful trends and targets for improvement Excellent interpersonal skills and demonstrated ability to establish rapport and working relationships with providers, service vendors and internal staff Willingness to explore innovative methods of providing medical management Supports the culture and models the MPHC values This position is not eligible for immigration sponsorship. We are an equal opportunity/affirmative action employer. Martin's Point complies with federal and state disability laws and makes reasonable accommodations for applicants and employees with disabilities. If a reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact ***************************** Do you have a question about careers at Martin's Point Health Care? Contact us at: *****************************

Who We Are BioMarin is a global biotechnology company that relentlessly pursues bold science to translate genetic discoveries into new medicines that advance the future of human health. Since our founding in 1997, we have applied our scientific expertise in understanding the underlying causes of genetic conditions to create transformative medicines, using a number of treatment modalities. Using our unparalleled expertise in genetics and molecular biology, we develop medicines for patients with significant unmet medical need. We enlist the best of the best - people with the right technical expertise and a relentless drive to solve real problems - and create an environment that empowers our teams to pursue bold, innovative science. With this distinctive approach to drug discovery, we've produced a diverse pipeline of commercial, clinical and preclinical candidates that have well-understood biology and provide an opportunity to be first-to-market or offer a substantial benefit over existing therapeutic options. About Worldwide Research and Development From research and discovery to post-market clinical development, our WWRD engine involves all bench and clinical research and the associated groups that support those endeavors. Our teams work on developing first-in-class and best-in-class therapeutics that provide meaningful advances to patients who live with genetic diseases. BioMarin Clinical Science (CLS) is responsible for overseeing clinical programs across various phases, from proof-of concept to Phase 3 and BLA/NDA/MAA filing. The Clinical Science team provides leadership for clinical strategy and oversight to ensure excellence in clinical trial conduct, data analysis and interpretation, publication preparation, and safety monitoring BioMarin Clinical Science (CLS) is responsible for overseeing clinical programs across various phases, from proof-of concept to Phase 3 and BLA/NDA/MAA filing. The Clinical Science team provides leadership for clinical strategy and oversight to ensure excellence in clinical trial conduct, data analysis and interpretation, publication preparation, and safety monitoring. Summary Description: Fully remote role - US based candidates The Medical Director has a key scientific and analytical leadership role in the development of CLS core deliverables across study planning, design and execution, results analysis and regulatory filings. Key focus areas include: acting as a study Medical Monitor and providing the scientific input into the creation and review of all CLS study deliverables and monitoring subject eligibility, study data and contributing critically to the scientific interpretation and integration of clinical study results.The Medical Director will also contribute to the scientific strategy and plan as outlined in the Clinical Development Plan (CDP). The Medical Director is also responsible for providing medical input into the creation and review of all CLS study deliverables to support clinical decision making, problem solving, and safety surveillance, as well as collaboration with external physician stakeholders. Key Responsibilities: Scientific Leadership Support the definition of the core clinical and scientific strategy that serves as the basis for the CDP and provide CLS expertise in the design and execution of clinical studies under the purview of the CDP Participate (as assigned) in the development of CLS-assigned sections of regulatory filings and in drafting regulatory responses in collaboration with Medical Writing Establish relationships with investigators and KOLs as appropriate in support of the CDP Stay up to date with advances in literature in therapeutic/disease area including mechanism of action, diagnostic tests, treatment, drug development trends, and regulatory requirements Develop therapy-specific publication plans and work with internal and external colleagues to prepare study results for timely publication Attend and contribute to relevant scientific conferences, seminars or presentations Clinical Study Planning and Monitoring Act as the scientific subject matter expert, and primary contact, for assigned clinical study; take a proactive approach to identifying issues and mitigating risk Initiate and provide the medical and scientific content and insight for development and review of: protocols, protocol amendments; ICFs; CRFs; statistical tables and listings including accurate AE (MedDRA) and concomitant medications (WHODrug) coding; audit reports; clinical study reports; inspection readiness activities, regulatory submissions and other key study deliverables Provide clinical input to statistical analysis plan to ensure alignment with Regulatory and business interests Facilitate the review and approval of all study related CLS deliverables and content Act as study scientific subject matter expert and main point of contact for Principal Investigators (PIs) and sites to assess subject eligibility, provide scientific rational and manage ongoing protocol issues Provide leadership to sites by developing or participating in training, answering investigator/site questions about the protocol Respond to site and Health Authority questions about the protocol Conduct periodic review of protocol deviations in collaboration with Clinical Operations Study Lead or designee (per protocol specific Protocol Deviation Plan) Attend and present at Investigator Meetings, as needed Conduct data review, assessment and interpretation of clinical data to ensure that the data are correct and presented with the appropriate interpretation including thorough review of SAEs and other important AEs (per the study specific Medical Monitoring Plan) Review and analyze SAEs, safety and efficacy trends on an ongoing basis Work closely with the Pharmacovigilance representatives providing medical input into safety reports including, SAE narratives and analysis of similar events, Development Safety Update Reports (DSURs) and Suspected Unexpected Serious Adverse Reactions (SUSARs) reports, Company Core Safety Information (CCSI), Investigator Brochure (IB), Risk Management Plans, Integrated Summaries of Safety and Efficacy, Clinical Study Reports and preparation of labels Participate in and provide scientific advice, as appropriate, during key Database Lock (DBL) activities (final listing review, review of blinded tables, listings and figures (TLFs), etc.) and actively participate in all data snapshots taken (not limited to final DBL) Collaborate with Biometrics to identify key issues, prepare content and facilitate discussions at study Data Review Board (internal) or Data Monitoring Committee (DMC) Lead the selection of and interactions with independent Data Monitoring Committees (DMC) The Medical Director will also act as the medical subject matter expert for review of clinical and safety data to ensure data are correct and presented with the appropriate medical interpretation and for discussing safety concerns with sites Governance and Communication Provide timely and high-quality functional deliverables and contributions to Study Execution Team (SET) Act as primary point of contact between SET and BCLS to ensure appropriate dissemination of information and communication (including functional managers and other relevant individuals) Provide agenda topics to be discussed during SET meetings Act as the medical and scientific subject matter expert (SME) to the SET with the ability to make decisions and recommendations on behalf of BCLS Proactively identify and communicate potential risks and mitigations relevant to the BCLS deliverables Contribute to the development and maintenance of study- specific plans; manage the development of study-specific plans that are the responsibility of BCLS Collaborate with BCLS Therapeutic Area Lead, CDTL and CSL on all study related decisions, as appropriate Escalate issues affecting BCLS function deliverable quality, timelines, resources or budget, as appropriate Competencies The Medical Director is expected to exhibit mastery-level understanding of multiple technical competencies, including scientific knowledge, data analysis, and scientific writing. S/he should also have advanced-level competence in several areas, including strategic thinking and problem solving. The Medical Director should: Identify scientific and medical knowledge gaps in therapeutic area and target populations to drive research and publication strategies Assess the clinical and medical impact of clinical and external research findings and data on overall therapeutic area and clinical development strategies Conduct comprehensive document evaluations including evaluation of statistical presentations, research methods, quality and completeness of content Identify internal and external best practices, trends, developments or alternative approaches that can be leveraged for strategy development Demonstrate ability to look beyond the obvious toward innovative approaches, avoiding biases and historical crutches The Medical Director will also demonstrate mastery of relevant clinical and therapeutic area knowledge to support clinical decision making, problem solving, safety surveillance, and as well as collaboration with external physician stakeholders. Education and Experience: MD, MD/PhD (or equivalent) Advanced degree in life or health sciences (e.g. PhD/PharmD/RN) 5 or more years of relevant experience in Clinical Development, with experience in genetic diseases, specialty care, and/or rare diseases desired; Clinical experience preferred Note: This description is not intended to be all-inclusive, or a limitation of the duties of the position. It is intended to describe the general nature of the job that may include other duties as assumed or assigned. Equal Opportunity Employer/Veterans/Disabled An Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status and will not be discriminated against on the basis of disability.

The Division of Pediatric Cardiology at Inova LJ Murphy Children's Hospital is seeking a full-time Pediatric Cardiologist to serve as Medical Director of Non-Invasive Cardiovascular Imaging to support our rapidly growing team within Inova Children's Heart Center. The Heart Center at Inova LJ Murphy Children's Hospital has been caring for the children of Northern Virginia and the Greater Washington Region for more than 30 years. Each year, the program is responsible for approximately 550 procedures. The program provides surgical repair of the most complex congenital heart defects, including hypoplastic left heart syndrome. In addition to providing care for children with complex congenital anomalies, the program provides a lifetime of care as part of the Inova Schar Heart and Vascular, which includes the Adult Congenital Program. Inova Children's Heart Center is a comprehensive team, including congenital cardiac surgery, outpatient cardiology, fetal cardiology, non-invasive cardiology, adult congenital cardiology, diagnostic and interventional catheterization, and electrophysiology and advanced heart failure therapies. The team includes 23 board-certified pediatric cardiologists, 8 pediatric cardiac intensivists, 3 pediatric cardiac surgeons and 17 advanced practice providers. With respect to non-invasive imaging, the division currently performs fetal, transthoracic, and transesophageal echocardiography, and partners with radiology on cMRI and CT scans. A team of inpatient and outpatient dedicated congenital sonographers support the division. The Pediatric Noninvasive Imaging Lab (ICAEL accredited) at Inova Children's Hospital is the largest program in Virginia performing 11,000 outpatient and 2,600 inpatient echocardiograms per year. Inova LJ Murphy Children's Hospital is a 226-bed children's hospital at Inova Fairfax Hospital medical campus, located in Northern Virginia. As the only dedicated children's hospital and pediatric heart center in Northern Virginia, we provide care in a welcoming environment that offers the latest in technical innovation in kid-friendly spaces. The children's hospital has a 108-bed, level IV Neonatal Intensive Care Unit with approximately 17,000 annual deliveries. The Pediatric Cardiac Intensive Care Unit and Acute Cardiac Care Unit are part of the Inova Children's Heart Center. Inova is consistently ranked as a national healthcare leader in safety, quality and patient experience. We are also proud to be consistently recognized as a top employer in both the D.C. metro area and the nation. Featured Benefits: Physician Led Organization: Potential for Physician leadership opportunities Committed to Team Member Health: Offering medical, dental and vision coverage, and a robust team member wellness program. Competitive Compensation Package: Competitive Base and Incentive program with opportunities for Sign-On, Retention, and Relocation bonuses Retirement: Inova matches the first 5% of eligible contributions - starting on your first day. 457B retirement plan is also available for physicians in a 0.5 FTE and greater CME Support: Up to $3,500 a year for CME support and up to 5 days of CME Tuition and Student Loan Assistance: offering up to $5,250 per year in education assistance and up to $10,000 for student loans. Work/Life Balance: offering paid time off and paid parental leave Medical Director, Pediatric Non-Invasive Cardiovascular Imaging Job Responsibilities: Support and mentor junior and mid-career pediatric cardiology echo attendings within the Pediatric Heart Center. Support and mentor ultrasound technicians within the Pediatric Heart Center. The candidate should have advanced training in non-invasive imaging while possessing professional, clinical, and leadership skills. This position will work with the Chief of Pediatric Cardiology and the leadership of the Inova Children's Heart Center to execute yearly personal and programmatic goals focused on the fundamentals of extraordinary care: Safety, quality, patient experiences, access, and stewardship. This is a perfect position for the candidate that thrives in an environment that focuses on teamwork, collaboration and dedication to patients, families, and each other. Although patient care is our primary focus, education and research are also encouraged and supported with access to dedicated research professionals including statisticians, research manager, and research coordinators. Professional responsibilities will include directing noninvasive imaging for the Pediatric Heart Center. Minimum Qualifications: Education: Doctorate Medicine MD or DO (completion of USMLE if non-US education) Training: Successful completion of physician residency program. Pediatric/Congenital Advanced Cardiac Imaging Fellowship Certification: Board eligible or Board Certified in Pediatric Cardiology. Licensure: Physician Upon Start; Current unrestricted license to practice medicine in the State of Virginia. Preferred Qualifications: The ideal candidate will have extensive experience (5+ years) in the field, specifically in echocardiography (TTE, TEE, strain analysis and 3D imaging) Preference will be given to those with experience at higher-volume centers and demonstrated leadership roles in imaging. The ideal candidate will have prior experience or education in medical administration, with preference given to those who also possess clinical research experience.

Job Responsibilities Develop and administer inter-reviewer reliability methodology to ensure medical necessity determinations are consistent with CMS published guidelines corporate medical review criteria, and medical policy guidelines. Analyze, evaluate and apply clinical metrics that produce actionable information in support of medical management and quality improvement initiatives. Direct and support physician review to ensure timeliness, accuracy and reliability of UM and Appeals reviews. Lead and serve on various committees in order to accomplish medical utilization, cost and quality objectives of BCBST. Willingness to travel within the State of Tennessee and nationally. Job Qualifications Education Current MD or DO degree with an unencumbered and unrestricted license to practice medicine in Tennessee required. *However, this requirement can be waived for jobs where the totality of the incumbents duties and responsibilities are restricted to the performance of administrative duties only. Based on business need, an unencumbered and unrestricted license in an alternative state may be substituted. Experience 5 years - Clinical experience required 5 years - Healthcare administration and/or UM experience preferred Skills\Certifications Board Certification in a recognized specialty by the American Board of Medical Specialties or the American Board of Osteopathic Specialists Ability to conceive and deliver innovative solutions Ability to work independently with minimal supervision or function in a team environment sharing responsibility, roles and accountability. Outstanding negotiation, presentation, and facilitation skills Proficient in Microsoft Office (Outlook, Word, Excel and Powerpoint) Ability to interpret and explain complex government policies Knowledge of Medicare programs Employees who are required to operate either a BCBST-owned vehicle or a personal or rental vehicle for company business on a routine basis* will be automatically enrolled into the BCBST Driver Safety Program. The employee will also be required to adhere to the guidelines set forth through the program. This includes, maintaining a valid driver's license, auto insurance compliance with minimum liability requirements; as defined in the “Use of Non BCBST-Owned Vehicle” Policy (for employees driving personal or rental vehicles only); and maintaining an acceptable motor vehicle record (MVR). *The definition for "routine basis" is defined as daily, weekly or at regularly schedule times. Number of Openings Available 0 Worker Type: Consultant Company: BCBST BlueCross BlueShield of Tennessee, Inc. Applying for this job indicates your acknowledgement and understanding of the following statements: BCBST will recruit, hire, train and promote individuals in all job classifications without regard to race, religion, color, age, sex, national origin, citizenship, pregnancy, veteran status, sexual orientation, physical or mental disability, gender identity, or any other characteristic protected by applicable law. Further information regarding BCBST's EEO Policies/Notices may be found by reviewing the following page: BCBST's EEO Policies/Notices BlueCross BlueShield of Tennessee is not accepting unsolicited assistance from search firms for this employment opportunity. All resumes submitted by search firms to any employee at BlueCross BlueShield of Tennessee via-email, the Internet or any other method without a valid, written Direct Placement Agreement in place for this position from BlueCross BlueShield of Tennessee HR/Talent Acquisition will not be considered. No fee will be paid in the event the applicant is hired by BlueCross BlueShield of Tennessee as a result of the referral or through other means.