Managed care director work from home jobs - 513 jobs

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.

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 .

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.

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

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.

Do you want to be part of an inclusive team that works to develop innovative therapies for patients? Every day, we are driven to develop and deliver innovative and effective new medicines to patients and physicians. If you want to be part of this exciting work, you belong at Astellas! Astellas Pharma Inc. is a pharmaceutical company conducting business in more than 70 countries around the world. We are committed to turning innovative science into medical solutions that bring value and hope to patients and their families. Keeping our focus on addressing unmet medical needs and conducting our business with ethics and integrity enables us to improve the health of people throughout the world. For more information on Astellas, please visit our website at ***************** This position is based in Northbrook, Illinois. Remote work from certain states may be permitted in accordance with Astellas' Responsible Flexibility Guidelines. Candidates interested in remote work are encouraged to apply. Purpose and Scope: * Responsible for overseeing the design and delivery of trials within a given late phase program or multiple early-phase programs in the Immuno-Oncology group. * Reports to the Medical Lead/disease area strategy head for the given program(s) and is accountable for defining the strategy and execution of assigned trials. * Clinical team leader with clear understanding of areas of responsibilities and accountabilities of the role. Team player who is comfortable in situations where the role serves as a consultant and support to other functions and particularly the asset area. Understands the criticality of information and knowledge management, partnership and collaboration required in drug development. Essential Job Responsibilities: * Collaborates effectively with key internal and external stakeholders as a member of the asset team and leader of the clinical study team to advance one or more clinical trials. Serves as Medical Monitor w/ responsibility for safety monitoring. * Ensures patient safety on clinical study is maintained. Generates safety related documents, such as medical monitoring reports and the safety database, to ensure that the reporting of SAEs is current and complete. * Collaborates closely with safety officer in writing and/or reviewing Safety Narratives, Investigator Letters, and other safety documentation for site-reported safety events. * Coordinates with Safety Officer on program for appropriate benefit-risk assessments, planning FIH study dose selection and escalation path for early-phase programs, safety management on trials, provides clinical input and review of clinical documents, statistical analysis plans, interim and final analyses on trials, publications, CSRs, DSURs and other critical documents. * Able to assimilate Research, Clinical Pharmacology, Biomarker, medical safety, Toxicology (early phase programs) regulatory, biostatistics, medical affairs, Health Economics, commercial perspectives into clinical development strategies and trial designs. * Responsible for managing the process of development of protocol and necessary regulatory documents. * Accountable and responsible for development and implementation, and execution of clinical trials as part of a large complex late phase (post POC, established market) program or a group of earlier stage programs, in alignment with Asset and overall clinical strategy. * In late phase program serves as the Lead for an indication specific clinical development team and is responsible and accountable for both strategy and execution of the clinical development plan for that indication or line of therapy. * In earlier phases, serves as the clinical lead for the entire clinical development strategy and execution for a given program. * Acquires public knowledge regarding therapeutic landscape, potential competitor products and serves as clinical voice regarding the potential for impact on planned clinical, medical affairs and commercial strategies. * Creates and maintains scientific/clinical networks and seeks external opinion leader as appropriate. Serve as the clinical interface during clinical advisory boards, investigator meetings, and interactions with opinion leaders. Serves as the clinical interface in regulatory authority interactions. * Accountable for clinical development milestones for their given trials. Supports Medical lead and Asset team at governance meetings and can present the clinical development plan in a succinct and clear manner at such meetings. * Works with Development Scientists and Clinical Operation Leads to ensure efficient and streamlined execution of clinical trials and acquisition and interpretation of high-quality clinical data to inform program-level decision making and overall development strategies. * Designs scientifically rigorous, cost-effective, and patient-centric clinical trials in accordance with the Clinical development Plan. Accountable for Clinical trial scope development and authoring of the protocol, IB, ICF as appropriate, in coordination with development scientists, clinical operations, medical writing and regulatory. * Responsible for keeping medical lead, asset lead and Development Head informed on progress of trials, risks, planned/required mitigations, and changes to timelines and budgets. * Supports clinical development related initiatives as needed. Leads and/or participates in scientific and medical training to other team members and external clients, investigators, and other site staff as it pertains to assigned studies.

At Eisai, satisfying unmet medical needs and increasing the benefits healthcare provides to patients, their families, and caregivers is Eisai's human health care (hhc) mission. We're a growing pharmaceutical company that is breaking through in neurology and oncology, with a strong emphasis on research and development. Our history includes the development of many innovative medicines, notably the discovery of the world's most widely-used treatment for Alzheimer's disease. As we continue to expand, we are seeking highly-motivated individuals who want to work in a fast-paced environment and make a difference. If this is your profile, we want to hear from you. The Associate Medical Director, US Medical Affairs - Alzheimer's Disease assists in the development of medical affairs strategy, planning and supportive tactics for assigned therapeutic area. The Associate Medical Director is responsible for working with key stakeholders to execute the medical affairs plan, including operationalizing post-marketing medical affairs studies and developing corresponding scientific communication and publication plans, congress management, medical education, review of proposals for research grants and CME, organizing and hosting medical advisory boards, and supporting internal training as needed. The Associate Medical Director utilizes expert medical, clinical and scientific knowledge in assigned Neuroscience to provide tactical input for the development of product strategies. Maintain relationships with external stakeholders to solicit feedback and strengthen Eisai's medical reputation in the disease state community. The Associate Medical Director is responsible for review and approval of medical and scientific content for all relevant materials/communications. Responsibilities: Provide inputs to the development of medical strategy Ensure tactical alignment with Medical Affairs Plans for assigned product(s) and prepare progress updates as needed. Participate in the design strategies, planning and implementation of medical affairs studies for assigned product(s). Contribute to the development of IIS strategies-, and review proposals in conjunction with company policies. Participate in review of CME grants. Serve as a medical resource providing direction for assigned products on key internal business processes including active participation in relevant medical review committees. Support timely and relevant communications with external customers, thought leaders, strategic alliances, key organizations, and institutions. Provide inputs to overall development of budget and resources including talent pool and address deviations. May provide mentoring, guidance and training to new hires/ less experienced colleagues. Qualifications: Advanced scientific degree (MD, PhD, PharmD) with 4+ years of experience in the pharma/ biotech industry or in academia. Practical knowledge of FDA regulations/ICH guidelines regarding conduct of clinical studies in relevant therapeutic area. Experience across areas of Medical Affairs' functions or phase II/III/IV clinical trials and diseases in the therapeutic area is preferred. Proven performance in earlier role. Skills:Communication & Cross-functional Influence, Critical Thinking & Business Agility, Healthcare Environment Dynamics, MA Strategic Thinking, Mentoring/ People Development, Resource Planning & Management, Technical Breadth (Medical Affairs) Eisai Salary Transparency Language: The annual base salary range for the Associate Medical Director, US Medical Affairs - Alzheimer's Disease is from :$177,200-$232,600Under current guidelines, this position is eligible to participate in : Eisai Inc. Annual Incentive Plan & Eisai Inc. Long Term Incentive Plan. Final pay determinations will depend on various factors including but not limited to experience level, education, knowledge, and skills. Employees are eligible to participate in Company employee benefit programs. For additional information on Company employee benefits programs, visit ********************************************************** Certain other benefits may be available for this position, please discuss any questions with your recruiter. Eisai is an equal opportunity employer and as such, is committed in policy and in practice to recruit, hire, train, and promote in all job qualifications without regard to race, color, religion, gender, age, national origin, citizenship status, marital status, sexual orientation, gender identity, disability or veteran status. Similarly, considering the need for reasonable accommodations, Eisai prohibits discrimination against persons because of disability, including disabled veterans. Eisai Inc. participates in E-Verify. E-Verify is an Internet based system operated by the Department of Homeland Security in partnership with the Social Security Administration that allows participating employers to electronically verify the employment eligibility of all new hires in the United States. Please click on the following link for more information: Right To Work E-Verify Participation

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

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: *****************************

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

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.

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.

Who We Are: NEXDINE Hospitality's family of brands provides dining, hospitality, fitness center and facility management services to businesses, independent schools, higher education, senior living, and hospitals nationwide. We put our people first to deliver finely tailored, expertly managed programs. The NEXDINE Experience is responsive, transparent, and authentic. Learn more at **************** Job Details: Position: Director of Hospitality Location: Dallas, TX Hours: Full Time Pay Frequency: Weekly - Direct Deposit What We Offer You: Generous Compensation & Benefits Package Health, Dental & Vision Insurance Company-Paid Life Insurance 401(k) Savings Plan Paid Time Off: Vacation, Holiday, Sick Time Employee Assistance Program (EAP) Career Growth Opportunities Employee Perks & Rewards Director of Hospitality Job Summary: We are seeking a dynamic and versatile professional to join our team as a Director of Hospitality Experience. This role requires a unique blend of skills and expertise to seamlessly coordinate and execute events, manage concierge services, and oversee facility coordination. The ideal candidate will be detail-oriented, customer-focused, and adept at multitasking in a fast-paced environment. Director of Hospitality Essential Functions and Key Functions: Collaborate with clients to understand their event requirements, preferences, and expectations. Plan, organize, and execute catering events, ensuring a seamless and memorable experience for clients and guests. Coordinate with vendors, including catering services, decorators, and entertainment providers, to ensure all aspects of the event are well-managed. Create detailed event timelines and manage event logistics to ensure timely execution. Address and resolve any issues or challenges that may arise during events. Provide exceptional concierge services to guests, including answering inquiries, making reservations, and offering personalized assistance. Maintain a professional and welcoming atmosphere for guests, ensuring their needs are anticipated and met. Handle guest complaints or concerns promptly and effectively, striving to exceed expectations. Keep abreast of local events, and services to provide guests with relevant information. Coordinate with maintenance staff to address any repairs or improvements needed in a timely manner. Manage scheduling and logistics for meeting rooms, ensuring availability and proper setup. Work closely with vendors to ensure the timely delivery of supplies and services. Develop and maintain relationships with facility-related service providers. Work Environment This job operates in a kitchen environment whereby employees may be exposed to and/or required to operate equipment, including but not limited to, an oven, stove, dishwasher, slicer, coffee machine, steamer, mixer and chef's knives. The employee is frequently exposed to heat, steam, fire and noise. This job will also include operating in an office environment. This role routinely uses standard office equipment such as computers, phones, televisions, photocopiers, filing cabinets and fax machines. Physical Demands The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. The employee is frequently required to sit, stand, walk, use hands to handle or feel; and reach with hands and arms. The position requires auditory & visual skills and the ability to follow written & oral instructions and procedures. Required Skills/Abilities Proven experience in event planning and coordination, with a focus on catering events. Strong interpersonal and customer service skills, with the ability to engage effectively with clients and guests. Excellent organizational and multitasking abilities to manage diverse responsibilities. Knowledge of concierge services and a commitment to delivering exceptional guest experiences. Facility management experience, including overseeing maintenance and coordinating logistics. Proficient in Microsoft Office and event planning software Required Education and Experience Bachelor's degree in Hospitality Management, Event Planning, or a related field preferred. Minimum of 3 years of relevant experience in catering, event planning, concierge services, or facility coordination.

Location: USA Remote | Job Type: Full-Time | Team: Sales Azira is a location intelligence platform built for today's data-driven teams, transforming mobile location signals into high-confidence, privacy-first insights. Our technology helps marketing, operations, and data leaders make smarter decisions, optimize performance, and drive measurable growth. From retailers and media agencies to destination marketers and real estate teams, we deliver trusted, validated insights rooted in real-world behavior-connecting the dots between where people go and how businesses can better reach, serve, and grow their audiences. Why This Role Matters As Sales Director, Hospitality, you will assist Azira's growth strategy among hotel chains and brands. In this role, you will be a part of the driving force behind expanding Azira's presence and elevating our brand with major hospitality companies and their partner agencies across North America. You will join a stellar sales team, and focus on the hospitality category, specifically branded properties and chains. Your role will be crucial to driving new business growth, and partner cross-functionally to deliver powerful solutions that blend data, insights, and media. This is a high-impact, high-visibility role that's critical to Azira's growth in a strategic vertical. We're looking for someone with a proven track record of driving sales growth with hotel brands and chains. The ideal candidate will have a solid understanding of the evolving trends, relationships and key brand priorities, as well as the broader advertising and marketing technology landscape, including programmatic, social, and CTV. We will prioritize candidates with proven success working with hotel chains, a passion for media and technology, and the drive to elevate the Azira brand to new heights. If this sounds like your world, let's talk! What You'll Do Assist in leading sales execution among chains and brands for the Hotel Vertical, from planning to close Build and manage a strong pipeline of hotel brands and agency partners through proactive outreach, networking, and relationship development Conduct discovery sessions, craft compelling pitches, and tailor proposals to align Azira's capabilities with client goals Close complex, enterprise-level deals and consistently exceed quarterly and annual revenue targets Collaborate with Product, Marketing, and Executive teams to shape category-relevant solutions Represent Azira at key industry events, conferences, and client meetings Share best practices and contribute to the broader Sales team's growth and development What You'll Bring 7+ years of enterprise sales experience and media experience, specifically in the hospitality vertical (required) Deep understanding of media buying on behalf of hotels and their flags (required) Proven success using a consultative sales approach to close complex, high-value deals and grow long-term partnerships in the hotel industry. Excellent communication and storytelling skills - you make technical solutions feel strategic and actionable Highly self-motivated with strong attention to detail and the ability to thrive in a fast-moving environment A collaborative mindset with a desire to work cross-functionally and win as a team Why You'll Love It Here Competitive base salary: $135,000 - $150,000 with the ability to double this through the achievement of on-target earnings Full medical, dental, vision, competitive 401k plan with a company match, and PTO benefits Flexible remote work environment (U.S. based) Opportunity to lead and grow a major category at a high-growth company Supportive, smart teammates who thrive on solving meaningful challenges A culture that values bold thinking, accountability, and fun How to Apply Sound like a fit? Apply here! At Azira, we don't hire for the box-we hire for the spark. We're building boldly. Join us.

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.

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.

NantHealth is adding a part time Medical Director, Rheumatology to the Eviti team. The Rheumatologist - Medical Director is a key clinical leader responsible for supporting and further developing the NantHealth, Inc. Eviti Solution as it relates to autoimmune and inflammatory diseases, including oversight of utilization management and clinical policy for high-cost immunomodulatory and biologic therapies. The role serves in a matrix leadership capacity across clinical operations, content development, and client engagement. The role works closely with the NantHealth Medical Office professional staff of specialty nurse practitioners and physician reviewers who conduct medical record and treatment plan review, systems input, and reporting to payer clients through the eviti | Connect platform. While this position does not include direct managerial oversight of staff, it provides clinical leadership, guidance, and subject-matter expertise across teams. The Eviti Solution Medical Office functions to ensure that treatments for autoimmune and inflammatory diseases-including biologic agents, targeted small molecules, immunosuppressive therapies, off-label use, and step-therapy sequencing-are consistent with evidence-based medicine, nationally recognized best practices, and payer-defined standards of medical necessity, with the goal of supporting delivery of high-quality, appropriate care to patients. This is a national-impact, part-time role, with the Rheumatologist - Medical Director serving as a key clinical interface between payer clients, treating physicians, and NantHealth clinical and content teams, supporting day-to-day treatment plan review activities through clinical influence and expertise. The Rheumatologist - Medical Director will serve as a primary clinical consultant for the eviti | Connect product, conducting peer-to-peer discussions with practicing rheumatologists and other specialty 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 autoimmune drug utilization management, this role will have defined responsibilities in the development and oversight of clinical policies related to autoimmune diagnostics and monitoring, including appropriate use of advanced imaging, laboratory testing, and immunologic/genetic assays where relevant to rheumatologic care. Responsibilities include collaboration with Clinical Content, Informatics, and specialty work groups to support the development, refinement, and ongoing maintenance of clinical guidelines for autoimmune conditions such as rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, lupus, vasculitis, and other systemic inflammatory diseases. The Director will participate in multidisciplinary clinical committees and work groups, ensure timely updates to guidance as standards of care evolve, and help align diagnostic and therapeutic decision-making with disease activity, prior treatment response, and line of therapy. This is a remote position, requiring availability for up to 5 hours per week. Responsibilities include, but are not limited to: Provide clinical leadership and oversight of autoimmune disorder policies, including imaging and genetics/genomics, within the NantHealth clinical library for designated clients and payer partners, assuming greater ownership as familiarity with NantHealth operations, content, and platforms grows. Serve as a medical liaison between the Chief Medical Officer, Clinical Content, Product, and Client teams, ensuring alignment of clinical strategy, policy development, and operational execution for autoimmune care. Demonstrate thought leadership and deep expertise in autoimmune disorders, collaborating with client clinical teams and participating in multidisciplinary work groups and committees focused on rheumatology, imaging, and genomics. Work closely with client leadership, NantHealth Content, and Product Management to identify new clinical opportunities, enhancements, and decision-support capabilities across systemic therapy, imaging, and precision medicine for autoimmune conditions. Provide clinical oversight and guidance for treatment plan reviews performed by certified nurses and nurse practitioners, ensuring consistency with evidence-based care or appropriate, well-documented medical exceptions. Serve as a primary clinical consultant, leading peer-to-peer discussions with treating physicians in a professional, collaborative, and clinically credible manner. Support the development and refinement of internal processes, quality metrics, and reporting standards to ensure consistent, high-quality, and timely service delivery within approved operational frameworks. Collaborate with Informatics and Clinical Content teams to ensure that autoimmune disorder, imaging, and genomics content remains current, accurate, and reflective of evolving standards of care. Participate in quality assurance, performance improvement, and internal educational initiatives, and provide ongoing education to clinical staff on advances in autoimmune disease management, imaging, and precision medicine. Maintain up-to-date knowledge of autoimmune disorder standards of care, emerging therapies, imaging modalities, and genomics trends, and apply this knowledge to clinical policy and decision-support development. Contribute to the clinical software development lifecycle, including requirements definition, design input, testing, implementation, and ongoing optimization of NantHealth applications. Through high-quality clinical leadership and client service, help enhance NantHealth's visibility, credibility, and value proposition in the autoimmune care marketplace while mentoring colleagues and fostering a culture of collaboration and continuous learning Education & Experience Requirements: Possess a Current Active Unrestricted Physician License in the United States or its territories Medical or scientific degree required (M.D. or D.O.). Board certification in Rheumatology and/or Clinical Immunology required. Minimum of 5 years of post-training clinical experience in rheumatology, with demonstrated expertise in managing complex autoimmune disorders and familiarity with evolving standards of care. Proven clinical leadership experience, with a record of scholarly activity, publications, or involvement in guideline development preferred. Required Knowledge, Skills, and Abilities: Strong understanding of rheumatology practice and the healthcare insurance landscape, including medical necessity, utilization management, and payer policy considerations for autoimmune conditions. Excellent organizational skills with strong attention to detail and the ability to manage multiple priorities effectively. 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. This is a part time, hourly position, budgeted at $175 / hour.

This opportunity will be on-site in Colorado, Oklahoma or Wisconsin. Cornerstone, part of The Pennant Group family, is currently seeking entrepreneurial-minded leaders with proven results in building and leading exceptional clinical teams - and has a passion for the home health, hospice and home care industry. Join us in making an impact and shaping the future of home healthcare! About the Opportunity: The CCO-in-Training (CCIT) Program is a 12-week, full time paid executive training program designed to prepare outstanding leaders for an opportunity to lead and manage clinical services and teams in a home health, hospice, or home care setting. CCITs learn how to drive results, cultivate a strong team culture, and develop a deep understanding of the unique business model that powers Pennant's success. Successful CCIT graduates may advance to lead one of our thriving agencies or future agencies, with continued mentorship and operational support from experienced clinical partners. As a CCIT, you will gain hands-on practical experience in high quality clinical care services, agency operations, administrative support, and people leadership skills to equip you to take on a more strategic and elevated Director of Clinical Services position (or equivalent). The CCIT program offers mentorship, cross-functional training, and real responsibility in a dynamic environment. Key Responsibilities: Engage in immersive, on-the-job training across clinical, operational and administrative management functions. Shadow department heads and front-line staff to understand the day-to-day rhythm of agency operations, processes, and clinical controls. Take the lead on real-time projects and contribute to meaningful improvements within your host agency. Prepare for a Director-level role by mastering staffing, team engagement, and community growth initiatives. Study relevant state regulations and best practices in home healthcare operations. Align leadership and interpersonal skills with our CAPLICO core values and mission. Qualifications: Current, unencumbered, active license to practice as a Registered Nurse, Speech-Language Pathologist, Occupational Therapist, or Social Worker in the state where services are rendered; must maintain applicable state licensure requirements at hire, and for the entire duration of employment. Minimum of one (1) year of experience required, preferably in a home health or hospice treatment setting. Current and nationally accredited CPR certification. Enthusiasm, passion for working with people, and an internal drive to improve the lives of individuals in our care. Must understand and adhere to the ethical standards of the respective licensure governing board. Must have a valid driver's license, current automobile insurance, and a safe driving record. Open to relocation based on available opportunities About Us: Cornerstone, an affiliate of The Pennant Group (NASDAQ: PNTG), is committed to delivering compassionate, personalized care to patients and families in the comfort of their own homes. As part of the Pennant family-a growing national network with over 180 affiliated locations across 14 states spanning home health, hospice, and senior living-we operate with the independence and flexibility that allow our local leaders to truly make a difference. Pennant Services provides robust clinical, legal, accounting, IT and HR support, enabling our teams to focus on delivering exceptional service and care. We are guided by the core values that shape Pennant's unique culture: Customer Second Accountability Passion for Learning Love One Another Intelligent Risk Taking Celebrate Ownership We believe in empowering our people, fostering excellence, and creating an environment where personal and professional growth thrives. Our culture makes Pennant a truly unique place to work. The employer for this position is stated in the job posting. The Pennant Group, Inc. is a holding company of independent operating subsidiaries that provide healthcare services through home health and hospice agencies and senior living communities located throughout the US. Each of these businesses is operated by a separate, independent operating subsidiary that has its own management, employees and assets. More information about The Pennant Group, Inc. is available at **************************** #onsite The employer for this position is stated in the job posting. The Pennant Group, Inc. is a holding company of independent operating subsidiaries that provide healthcare services through home health and hospice agencies and senior living communities located throughout the US. Each of these businesses is operated by a separate, independent operating subsidiary that has its own management, employees and assets. More information about The Pennant Group, Inc. is available at ****************************

This is a remote position supporting New Mexico. Candidate needs to be licensed in the State where they reside. Maintains accountability for medical management functions to achieve the business and clinical outcomes for the health plan, meeting contract requirements, National Committee of Quality Assurance (NCQA) accreditation standards, and supporting initiatives with providers and members to manage cost of care. Oversees utilization management and criteria-based reviews of care, clinical appeals regarding medical necessity, and the interaction with claims payment policies and processes. Also oversees the health plans 24/7 Nurse Line program and the clinical management of crisis calls. Depending on SBU/product supported, supports goals, contracts, and accreditation requirements of health plan in conducting reviews of clinical interactions and clinical documentation including reviews of case management, utilization management, vendor, and provider records. Collects data following established procedures and analyzes findings for purposes of continuous quality improvement and for internal and external reporting. Interacts with multiple stakeholders internally and externally. Conduct staff audits, process audits and pre-delegation and delegation activities. Reviews audit results with appropriate stakeholder and manages trainings in conjunction with the trainer for individual and/or for unit learning gaps. Directs, coordinates and evaluates efficiency and productivity of utilization management functions. Works closely with SBU and vendors to assure integration, oversight, and efficiency of utilization management and appeals processes and for delegated functions. In collaboration with the national clinical team, assures that all utilization management-related activities meet the standards required for the state contract and NCQA. Leads and organizes the ongoing evaluation of the utilization management program against quality and utilization benchmarks and targets. Identifies opportunities for improvement; organizes and manages cost of care initiatives. Collaborates with local and national leaders including Quality Improvement, Analytics, Finance, Network, and other areas to assure a comprehensive approach to managing quality of care, service, and cost of care. Provides expert input to Finance regarding patterns of utilization and cost and high cost cases. Assures staff selection, training, and evaluation to promote the development of a high quality team and effective transitions of care with the clinical care teams. Works closely with and provides input to national health plan clinical team on program design, policies, procedures, workflows, and correspondence. Collaborates with Network leaders to design and implement successful methods for working with hospitals, home health, and other services providers. Ensures integration and efficiency of Network strategy and vendor relationships with utilization management and claims processes. Works closely with network on the training and evaluation of providers as well in resolving provider related issues. Directs staff who assure quality, inter-rater reliability and standards are met in daily operations. Responsible for resolution and communication of utilization management issues and concerns and corrective action plan activities and reporting. Participates as a member of health plan Quality Insurance Committee and co-chair health plan Utilization Management Committee. Collects, analyzes and prepares record/documents information for projects related to assessing the efficiency, effectiveness and quality of the delivery of managed care services. Prepares monthly performance reports with audit results. Presents findings at provider, customer, UM and CM meetings as needed. Audits and reviews case manager, Health guide, UM staff, vendor, and provider documentation and telephone interactions against health services quality monitoring standards, regulations, accreditation standards and contract requirements. Reviews vendor and/or provider records against clinical and procedural established standards and contract requirements. Leads and conducts ongoing activities which monitor established quality of care standards in the participating provider network, vendors, UM staff, Health Guides, and for case managers. Assists in the planning and implementation of activities to improve delivery of services and quality of care including the development and coordination of in-service education programs for vendors, providers, UM staff, and case managers. Makes recommendations as to required training based upon audit results. Responsible for monitoring and validating internal audit results and/or corrective action plans. Other duties as assigned. The job duties listed above are representative and not intended to be all-inclusive of what may be expected of an employee assigned to this job. A leader may assign additional or other duties which would align with the intent of this job, without revision to the job description. Other Job Requirements Responsibilities 3+ years in utilization management operations. 5+ years in health care quality improvement. Licensure is required for this position, specifically a current license that meets State, Commonwealth or customer-specific requirements. One or more of the following current, active licenses are required: BCBA, LCMFT, LCSW, LMHP, LPC, LPT, LOT or RN. Must have experience overseeing contractual performance standards. Experience with reporting and analyzing managed care utilization data. Strong verbal and written communications skills. General Job Information Title Director, Clinical Care Services - New Mexico, Remote Grade 30 Work Experience - Required Clinical, Management/Leadership, Quality, Utilization Management Work Experience - Preferred Education - Required Bachelor's - Nursing, Bachelor's - Occupational Therapy, Bachelor's - Physical Therapy, Master's - Behavioral Health Education - Preferred License and Certifications - Required BCBA - Board Certified Behavior Analyst - Care MgmtCare Mgmt, LCMFT - Licensed Clinical Marriage and Family Therapist - Care MgmtCare Mgmt, LCSW - Licensed Clinical Social Worker - Care MgmtCare Mgmt, LMFT - Licensed Marital and Family Therapist - Care MgmtCare Mgmt, LMHP - Licensed Mental Health Professional - Care MgmtCare Mgmt, LPC - Licensed Professional Counselor - Care MgmtCare Mgmt, OT - Occupational Therapist, State Licensure - Care MgmtCare Mgmt, PT - Physical Therapist, State Licensure - Care MgmtCare Mgmt, RN - Registered Nurse, State and/or Compact State Licensure - Care MgmtCare Mgmt License and Certifications - Preferred Salary Range Salary Minimum: $105,230 Salary Maximum: $178,890 This information reflects the anticipated base salary range for this position based on current national data. Minimums and maximums may vary based on location. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. This position may be eligible for short-term incentives as well as a comprehensive benefits package. Magellan offers a broad range of health, life, voluntary and other benefits and perks that enhance your physical, mental, emotional and financial wellbeing. Magellan Health, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled. Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.