Medical consultant jobs near me - 552 jobs

When you join the team at Unum, you become part of an organization committed to helping you thrive. Here, we work to provide the employee benefits and service solutions that enable employees at our client companies to thrive throughout life's moments. And this starts with ensuring that every one of our team members enjoys opportunities to succeed both professionally and personally.

Explore opportunities with Caretenders, a part of LHC Group, a leading post-acute care partner for hospitals, physicians and families nationwide. As members of the Optum family of businesses, we are dedicated to helping people feel their best, including our team members who create meaningful connections with patients, their families, each other and the communities we serve. Find a home for your career here. Join us and embrace a culture of Caring. Connecting. Growing together. As the Clinical Director, you will oversee and direct the patient care operations of the home care facility. This includes: coordinating and completing assigned projects to effectively support the immediate and long range objectives of the company; oversight of the eligibility of patients referred to home care services, planning for the services to be provided to patients and supervising their total home health care; implementing and maintaining administrative practices, agency philosophy, goals, and policies which assure compliance with applicable state and federal regulations; enhancing the profitability of the agency; and providing motivation and retention of a qualified staff and assure the quality of services delivered. This position also acts as a liaison with management staff and other departments throughout the company. Primary Responsibilities: Coordinates and completes assigned projects to effectively support the immediate and long-range objectives of the company Oversees the eligibility of patients referred to home care services, planning for the services to be provided to patients and supervising their total home health care Implements and maintains administrative practices, agency philosophy, goals, and policies which assure compliance with applicable state and federal regulations. Enhances the profitability of the agency; and providing motivation and retention of a qualified staff and assure the quality of services delivered All CMS and state regulations must be followed regarding supervision of nursing services If Clinical Director is not an RN, Executive Director/Administrator or Patient Care Manager must be designated as supervising RN for nursing services unless state regulations dictate otherwise You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications: Current and unrestricted RN licensure in the state of practice or PT/OT/SLP, must have current applicable license in the state Current CPR certification Current Driver's License and vehicle insurance, and access to a dependable vehicle, or public transportation #LHCjobs Preferred Qualifications: 1+ years of supervisory and/or management experience in home health setting or related healthcare setting Ability to manage multiple tasks simultaneously Able to work independently Good communication, writing, and organizational skills Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $71,200 to $127,200 annually based on full-time employment. We comply with all minimum wage laws as applicable. At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

Become a part of our caring community and help us put health first The Medical Director relies on medical background and reviews health claims. The Medical Director work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.

Job Description Geriatric Care for Seniors in Columbus, Ohio Medical Director Physician Must have leadership experience Including direct physician reports (not mid-levels) Process improvement experience Smaller patient panels Join an expanding state-of-the-art senior care practice Convenient family-friendly locations in Columbus Staff of talented primary and specialty care physicians Collaborative and team-based approach to geriatric care Outpatient only setting with 1:10 or better phone call S

Permanent Associate Medical Director Opportunity Available What we Offer: Schedule: M- F 8am to 5pm, No Weekends Competitive Pay: $250k to $270k. depends on experience Sign On Bonus: $30,000 Full Benefits Package - Medical, dental, vision, disability & life insurance. 401(k). What the Associate Medical Director will Do: 80% Clinical / 20% Administration Supervise and coach fellow providers in how to provide excellent primary care / urgent care and community care Partake in leadership meeting and also act as an ambassador to community based organizations, hospitals, and payers Requirements of the Associate Medical Director: 5+ Years clinical experience / Administrative leadership experience needed Active and unrestricted medical or nursing license in the state required Background in working for a clinic or community based inpatient setting a plus

Medical Director - Medicare Programs Remote | Approx. $300,000 base + significant bonus potential About the Opportunity: A leading national healthcare contractor is seeking a Medical Director to provide clinical leadership and decision-making support for Medicare operations. This position plays a critical role in developing and enforcing coverage determinations, reviewing complex claims, and promoting evidence-based medical policy. The role is ideal for a physician, especially those with a background in Physical Medicine and Rehabilitation (PM&R), who wishes to transition from direct patient care into a leadership position influencing medical necessity and healthcare compliance at scale. Key Responsibilities: Clinical Leadership: Provide medical expertise for claim reviews, appeals, and Medicare policy development. Serve as a subject matter expert across multiple specialties. Policy Development: Collaborate with the Centers for Medicare & Medicaid Services (CMS) and other contractors to create, revise, and maintain Local Coverage Determinations (LCDs) and related guidance. Program Integrity: Identify trends in billing or compliance issues and work with investigative teams to address improper claims. Medical Review & Appeals: Oversee quality assurance in pre- and post-payment medical review determinations and assist with administrative law proceedings when necessary. Provider Education: Lead outreach and training for healthcare providers and professional associations to ensure adherence to Medicare policies and evidence-based practices. Travel is minimal (approximately 3-4 weeks per year), and the position is fully remote with occasional in-person meetings or conferences. Required Qualifications: MD or DO from an accredited institution. Active, unrestricted medical license in at least one U.S. state (must be eligible for additional licensure where required). Board Certification in a specialty recognized by the American Board of Medical Specialties (minimum three years). At least three years of experience as an attending physician. Prior experience within the Medicare, health insurance, or utilization review environment. Strong understanding of clinical evidence evaluation and medical necessity determination within fee-for-service structures. Excellent communication and collaboration skills across technical, regulatory, and clinical teams. Computer proficiency (MS Office, data analysis tools, virtual collaboration platforms). Preferred Qualifications: Background in PM&R, Internal Medicine, Oncology, Radiology, Ophthalmology, or Infectious Disease. Five or more years of clinical practice experience. Prior experience as a Medical Director in a Medicare or commercial payer organization. Familiarity with HCPCS, CPT, and ICD-10 coding standards. Advanced degree or coursework in healthcare administration or systems management (MBA, MHA, MS). Experience performing systematic literature reviews or using GRADE methodology. Compensation & Benefits: Base salary: Approximately $300,000, flexible depending on experience. Bonus structure: Significant performance-based bonuses. Benefits: Comprehensive health coverage, generous retirement contributions, paid time off, and strong professional development support. Schedule: Full-time, remote position with flexible hours. Why Join: This is an opportunity to move beyond clinical work while continuing to make a direct impact on patient access and policy integrity at a national level. Join a mission-driven organization that values medical expertise, promotes collaboration, and advances fairness and compliance within the U.S. healthcare system.

Medical Director (Utilization Management) The Medical Director plays a key role in ensuring coverage and payment determinations are clinically appropriate, compliant, and aligned with plan benefits and contractual agreements with participating provider networks. This position requires sound clinical judgment, collaborative leadership, and a strong understanding of healthcare delivery, population health, and payer operations. Key Responsibilities Provide physician leadership and clinical guidance to Utilization Management and Care Management functions Render coverage and payment determinations in accordance with health plan benefits, medical policies, and provider contracts Apply evidence-based clinical guidelines and best practices to support consistent, high-quality decision-making Exercise informed medical judgment grounded in clinical medicine, patient safety, quality management, and population health principles Collaborate effectively with clinical teams, operational leaders, senior management, and external partners Promote efficient, cost-effective care delivery across all lines of business Support organizational initiatives related to quality improvement, compliance, and healthcare outcomes Required Qualifications & Experience Medical Doctor (MD) or Doctor of Osteopathy (DO) from an accredited medical or osteopathic medical school recognized by AAMC, AOA, or WHO Unrestricted and active Pennsylvania medical or osteopathic license Current board certification through ABMS or AOBMS (Family Medicine or Internal Medicine preferred) Ability to successfully complete organizational credentialing requirements Strong knowledge of Utilization Management, healthcare delivery systems, and payer-based medical decision-making Work Location Fully Remote: This position is designated as fully remote Work must be performed within the Tri-State Area (Pennsylvania, New Jersey, or Delaware)

Reports Jointly To: Chief Executive Officer and Chief Medical Officer Clinical Specialty: MD, Board Certified in Sports Medicine (primary board specialty flexible) ViewFi is a nationwide virtual musculoskeletal (MSK) practice bringing high-quality orthopedic, sports-medicine, and physical-therapy care directly to patients in both traditional and non-traditional markets. We serve a diverse set of partners including personal injury/med-legal groups, self-insured employers, risk-based payers, and digital health collaborators in the sports and fitness markets through technology enabled, evidence-based clinical care. We are redefining what excellent MSK care looks like in a virtual environment. Position Summary The Medical Director will serve as the clinical leader of ViewFi's physician team and a core partner to our physical therapy, product, operations, and business teams. This role requires a practicing, board-certified Sports Medicine physician who can balance patient care with 30-40% administrative/leadership responsibilities. The Medical Director will ensure clinical excellence, maintain high-quality and consistent clinical pathways, represent ViewFi as the medical voice of the organization, and advance the science and evidence behind virtual MSK care. Key Responsibilities Clinical Leadership & Oversight Lead, oversee, and support the national team of physicians delivering virtual MSK care. Maintain and update clinical pathways, treatment standards, and practice guidelines across all ViewFi service lines. Partner closely with the Physical Therapy leadership team to ensure integrated, cohesive care between MDs and PTs. Ensure consistent, high-quality clinical documentation, coding accuracy, and compliance across markets. Oversee peer review, quality assurance activities, and clinical performance metrics. Participate in recruitment, onboarding, and ongoing development of new clinicians. Patient Care (70-80%) Actively see patients in a virtual setting, providing MSK consults and follow-ups. Model best-in-class virtual care workflows and contribute to continuous improvement of the patient experience. Support escalated or complex cases requiring senior clinical judgment. Strategic & Administrative Leadership (20-30%) Serve as the medical voice of ViewFi at conferences, webinars, panels, and partner meetings. Collaborate with executive leadership on product development, new service lines, geographic expansion and clinical innovation initiatives. Guide medical input for payers, partners, self-insured employers, and med-legal groups. Participate in strategic planning related to national expansion, licensure strategy, and resource allocation. Work cross-functionally with operations and technology teams to enhance clinical workflows. Provide medical insight and feedback on ViewFi's technology roadmap, including clinical decision support, AI integration, and general telehealth tools. Research, Publishing & Thought Leadership Lead or collaborate on clinical research demonstrating the efficacy of virtual MSK care, including both MSK MD consults and virtual PT. Publish and present outcomes, case series, and efficacy studies at relevant medical and industry conferences. Help build ViewFi's reputation as the leader in evidence-based virtual MSK care. Quality, Compliance & Risk Management Ensure the practice meets state and federal clinical guidelines, telehealth regulations, and licensure requirements. Maintain oversight of clinical incident review processes, risk-mitigation protocols, and outcome tracking. Drive continuous improvement in clinical quality, patient safety, and service reliability. Qualifications MD with Board Certification in Sports Medicine (primary board: FM, IM, EM, PM&R, etc. is flexible). Multi-state licensure required; willingness to pursue additional licensure required. Minimum 10 years of clinical experience; virtual care experience strongly preferred. Demonstrated leadership experience in a clinical or medical director role. Strong collaboration skills with PTs, operational teams, and cross-functional partners. Excellent communication and presentation skills; comfortable representing ViewFi publicly. Passion for virtual care, musculoskeletal medicine, and innovative delivery models. What We Offer Opportunity to lead a national MSK practice at the forefront of technology enabled virtual healthcare Collaborative environment with clinical and operational teams aligned around quality care and aggressive growth Competitive compensation with protected administrative time Support for conference travel, research, publishing, and clinical innovation Commitment to clinical excellence, patient outcomes, and provider support

Division Practice Manager - Insights & Data Location: Sogeti North East Division (Connecticut, D.C., Maryland, Massachusetts, New Jersey, New York, Pennsylvania and Virginia) As a Division Practice Manager for Insights & Data (I&D), you will drive presales efforts for large-scale Data and AI programs, lead a high-performing team of data and analytics professionals, drive client engagements, and ensure delivery excellence across the I&D portfolio. This role requires strong thought leadership, strategic vision, and the ability to deliver innovative data-driven solutions that create measurable business value for our clients. What you will do at Sogeti: Presales Leadership: Drive presales efforts for large-scale Data and AI programs, including solutioning and proposal development. Team Management: Lead and mentor a team of data engineers, BI specialists, automation experts, and data scientists. Oversee engagements, talent acquisition, and professional development. Engagement Delivery: Manage complex, large-scale data and analytics programs, including strategy, implementation, and operational run phases. Client Partnership: Serve as a trusted advisor to clients, ensuring exceptional service delivery, managing expectations, and presenting insights effectively. Solution Ownership: Own end-to-end solutioning, client management, and delivery of data and analytics projects. Business Growth: Collaborate with account teams on pre-sales activities, research, and solutioning. Partner with alliances for joint go-to-market opportunities. Capability Development: Drive continuous improvement of data and analytics capabilities, develop new assets, and contribute to go-to-market strategies. What you will bring: Proven experience in presales, with a track record of selling Data and AI programs valued at $10M+. 10+ years of experience delivering large-scale data and analytics engagements. Expertise across the full data lifecycle: integration, management, architecture, governance, quality, automation, and data science. Ability to define business cases, measure outcomes, and communicate insights through compelling storytelling. Strong client-facing skills, capable of engaging at all levels from executives to engineers. Hands-on technical proficiency and ability to coach teams when needed. Deep knowledge of data and analytics ecosystems across Azure (required), AWS, and Google Cloud, including tools such as SQL, Azure Data Lake, Synapse, Azure ML, and Purview. Must be located in the Columbus or Cincinnati Ohio. Personal Attributes Strategic thinker and thought leader with strong executive presence. Thrives in a fast-paced, agile environment. Highly motivated, self-driven, and accountable for delivering exceptional client outcomes. Able to work independently with minimal supervision. Education Bachelor's or Master's degree in Computer Science, Software Engineering, Information Systems, Business Administration, or a related field. Life at Sogeti - Sogeti supports all aspects of your well-being throughout the changing stages of your life and career. For eligible employees, we offer: Flexible work options 401(k) with 150% match up to 6% Employee Share Ownership Plan Medical, Prescription, Dental & Vision Insurance Life Insurance 100% Company-Paid Mobile Phone Plan 3 Weeks PTO + 7 Paid Holidays Paid Parental Leave Adoption, Surrogacy & Cryopreservation Assistance Subsidized Back-up Child/Elder Care & Tutoring Career Planning & Coaching $5,250 Tuition Reimbursement & 20,000+ Online Courses Employee Resource Groups Counseling & Support for Physical, Financial, Emotional & Spiritual Well-being Disaster Relief Programs About Sogeti Part of the Capgemini Group, Sogeti makes business value through technology for organizations that need to implement innovation at speed and want a local partner with global scale. With a hands-on culture and close proximity to its clients, Sogeti implements solutions that will help organizations work faster, better, and smarter. By combining its agility and speed of implementation through a DevOps approach, Sogeti delivers innovative solutions in quality engineering, cloud and application development, all driven by AI, data and automation. Become Your Best | ************* Disclaimer Capgemini is an Equal Opportunity Employer encouraging diversity in the workplace. All qualified applicants will receive consideration for employment without regard to race, national origin, gender identity/expression, age, religion, disability, sexual orientation, genetics, veteran status, marital status or any other characteristic protected by law. This is a general description of the Duties, Responsibilities and Qualifications required for this position. Physical, mental, sensory or environmental demands may be referenced in an attempt to communicate the manner in which this position traditionally is performed. Whenever necessary to provide individuals with disabilities an equal employment opportunity, Capgemini will consider reasonable accommodations that might involve varying job requirements and/or changing the way this job is performed, provided that such accommodations do not pose an undue hardship. Capgemini is committed to providing reasonable accommodation during our recruitment process. If you need assistance or accommodation, please reach out to your recruiting contact. Please be aware that Capgemini may capture your image (video or screenshot) during the interview process and that image may be used for verification, including during the hiring and onboarding process. Click the following link for more information on your rights as an Applicant ************************************************************************** Applicants for employment in the US must have valid work authorization that does not now and/or will not in the future require sponsorship of a visa for employment authorization in the US by Capgemini. Capgemini discloses salary range information in compliance with state and local pay transparency obligations. The disclosed range represents the lowest to highest salary we, in good faith, believe we would pay for this role at the time of this posting, although we may ultimately pay more or less than the disclosed range, and the range may be modified in the future. The disclosed range takes into account the wide range of factors that are considered in making compensation decisions including, but not limited to, geographic location, relevant education, qualifications, certifications, experience, skills, seniority, performance, sales or revenue-based metrics, and business or organizational needs. At Capgemini, it is not typical for an individual to be hired at or near the top of the range for their role. The base salary range for the tagged location is $190,000 - $210,000. This role may be eligible for other compensation including variable compensation, bonus, or commission. Full time regular employees are eligible for paid time off, medical/dental/vision insurance, 401(k), and any other benefits to eligible employees. Note: No amount of pay is considered to be wages or compensation until such amount is earned, vested, and determinable. The amount and availability of any bonus, commission, or any other form of compensation that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law.

This role works closely with Care Team Operations, Clinical Operations, Behavioral Health clinicians (LMFT/LCSW/LPCC), Community Health Workers (CHWs), Compliance, Finance (for authorizations), Care Operations Associates, and external partners including hospitals, primary care providers, behavioral health agencies, housing providers, and community-based organizations. Responsibilities Serve as the primary point of contact for assigned members with behavioral health and psychosocial complexity, building trust through consistent, trauma-informed engagement. Conduct comprehensive, holistic assessments addressing behavioral health, substance use, functional status, social determinants of health, safety risks, and care gaps. Develop, implement, and maintain person-centered care plans that integrate behavioral, medical, and social goals; update plans following transitions of care or changes in condition. Coordinate services across the continuum of care, including behavioral health providers, primary care, hospitals, housing supports, transportation, social services, and community-based organizations. Conduct required in-person home or community visits based on acuity, risk stratification, and payer requirements. Support Transitions of Care (TOCs) by completing timely follow-up, coordinating post-discharge services, and reinforcing discharge instructions and medication understanding. Utilize motivational interviewing, behavioral coaching, and health education to promote engagement, adherence, self-management, and long-term member stability. Identify, escalate, and address behavioral health risks, safety concerns, service delays, benefit lapses, and environmental barriers using HHN escalation protocols. Coordinate and track referrals, appointments, transportation, and follow-ups to ensure continuity and timeliness of care. Maintain accurate, timely, and audit-ready documentation of all assessments, encounters, and interventions in eClinicalWorks (ECW) and other HHN systems. Meet or exceed HHN and health plan productivity standards, including outreach cadence, encounter requirements, documentation timeliness, TOC completion, and quality measures. Actively participate in multidisciplinary case reviews, care conferences, team huddles, and escalations with nurses, behavioral health clinicians, CHWs, care operations, and compliance. Assist members with plan navigation, eligibility redeterminations, social service applications, housing resources, and crisis intervention support. Communicate professionally with members and care partners using HHN-approved channels, including phone, RingCentral, secure messaging, and SMS workflows. Contribute to continuous quality improvement efforts by identifying workflow gaps, documenting barriers, and sharing insights to improve care delivery. Uphold confidentiality and comply with all HIPAA, Medi-Cal, ECM, and payer regulatory requirements. Remain flexible and responsive to member needs, including field-based work and engagement in community settings. Skills Required Bilingual (English/Spanish) proficiency required to support member engagement and care coordination. Strong ability to build rapport and trust with diverse, high-need member populations. Proficiency in using eClinicalWorks (ECW), Google Suite (Docs, Sheets, Drive), RingCentral, and virtual communication tools. Ability to interpret and use PowerBI dashboards, reporting tools, and payer portals. Demonstrated skill in conducting holistic assessments and developing person-centered care plans. Experience with motivational interviewing, trauma-informed care, or health coaching. Strong organizational and time-management skills, with the ability to manage a complex caseload. Excellent written and verbal communication skills across in-person, telephonic, and digital channels. Ability to work independently, make sound decisions, and escalate appropriately. Knowledge of Medi-Cal, SDOH, community resources, and social service navigation. High attention to detail and commitment to accurate, audit-ready documentation. Ability to remain calm, patient, and professional while supporting members facing instability or crisis. Comfortable with field-based work, home visits, and interacting in diverse community environments. Cultural humility and demonstrated ability to work effectively across populations with varied lived experiences. Competencies Member Advocacy: Champions member needs with urgency and integrity. Operational Effectiveness: Executes workflows consistently and flags process gaps. Interpersonal Effectiveness: Builds rapport with diverse populations. Collaboration: Works effectively within an interdisciplinary care model. Decision Making: Uses judgment to escalate or intervene appropriately. Problem Solving: Identifies issues and creates practical, timely solutions. Adaptability: Thrives in a fast-growing, startup-style environment with evolving processes. Cultural Competence: Engages members with respect for their lived experiences. Documentation Excellence: Produces accurate, timely, audit-ready notes every time. Strong empathy, cultural competence, and commitment to providing individualized care. Ability to work effectively within a multidisciplinary team environment. Exceptional interpersonal and communication skills, with a focus on building trust and rapport with diverse populations. Job Requirements Education: Bachelor's degree in Social Work, Psychology, Public Health, Human Services, or related field. Licensure: Licensed LMFT, LCSW, LPCC.; certification in care coordination or CHW training is a plus. Experience: 1-3 years of care management or case management experience, preferably with high-need Medi-Cal populations. Experience in community-based work, homelessness services, behavioral health, or SUD settings strongly preferred. Familiarity with Medi-Cal, ECM, and community resource navigation. Travel Requirements: Regular travel for in-person home or community visits (up to 45%). Physical Requirements: Ability to perform home visits, climb stairs, sit/stand for prolonged periods, and lift up to 20 lbs if needed.

Site: Mass General Brigham Health Plan Holding Company, Inc. 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 is an exciting place to be within the healthcare industry. As a member of Mass General Brigham, we are on the forefront of transformation with one of the world's leading integrated healthcare systems. Together, we are providing our members with innovative solutions centered on their health needs to expand access to seamless and affordable care and coverage. Our work centers on creating an exceptional member experience - a commitment that starts with our employees. Working with some of the most accomplished professionals in healthcare today, our employees have opportunities to learn and contribute expertise within a consciously inclusive environment where diversity is celebrated. We are pleased to offer competitive salaries, and a benefits package with flexible work options, career growth opportunities, and much more. Under the direction of the Senior Medical Director, the Medical Director leads as a senior physician at the health plan. This position works closely with the Senior Medical Director in providing medical management leadership for clinical services operations and programs. This role focuses on and has expertise in utilization management, health plan quality and accreditation, care management, and other health plan functions. Qualifications Licensure and Credentials: Must maintain an active full physician license in Massachusetts Experience: 3-5 years of Health Plan experience at least 5 years of clinical practice experience Job Duties: 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 •Reviews clinical services and quality incidents when sufficiently serious to merit physician involvement •Coverage of medical necessity determinations to support special investigations/fraud waste and abuse cases •Collaborates on health plan medical policy development •Assesses new, emerging, and existing technologies to determine appropriateness of health plan coverage •Partners with clinical leaders to ensure medical service expenditures remain within budget •Collaborates with business development, quality, finance and medical management teams to promote improvements in the quality and cost efficiency of care throughout the MGB Health Plan provider network •Delivers consultation to network management staff and deployment of education programs for network clinicians •Develops and delivers presentations for clinical staff on current topics relevant to MGB Health Plan members and network •May represent MGB Health Plan at a variety of external forums and committees •Interact, communicate and collaborate with network and community physicians, hospital leaders and other vendors regarding care and services for enrollees •Monitors performance metrics and audits to identify areas for continuous improvement and ensure compliance •Anticipates and meets or exceeds internal and/or external customer expectations and requirements; establishes and maintains positive relationships with customers and gains their trust and respect •Build strong relationships and infrastructure that designate MGB Health Plan as a people-first organization •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, exempt •In person meetings as requested for business needs •Participates in after hours and weekend call rotation as assigned Remote Type Remote Work Location 399 Revolution Drive Scheduled Weekly Hours 40 Employee Type Regular Work Shift Day (United States of America) EEO Statement: Mass General Brigham Health Plan Holding Company, Inc. 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.

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 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.

DCI Donor Services, Inc. (DCIDS) is looking for a dynamic and enthusiastic team member to join us to save lives!! Our mission at DCIDS is to save lives through organ and tissue donation, and we want professionals on our team that will embrace this important work!! DCI Donor Services is seeking a Donor Eligibility Associate / Medical Record Reviewer to join our team! This position will perform a medical record review and ensure quality assurance for potential tissue donors The Donor Eligibility Associate will work closely with Medical Directors and hospital personnel to receive, compile and prepare written summaries for tissue release. This is a perfect opportunity for someone who has previous experience with medical terminology! COMPANY OVERVIEW AND MISSION For over four decades, DCI Donor Services has been a leader in working to end the transplant waiting list. Our unique approach to service allows for nationwide donation, transplantation, and distribution of organs and tissues while maintaining close ties to our local communities. DCI Donor Services operates three organ procurement/tissue recovery organizations: New Mexico Donor Services, Sierra Donor Services, and Tennessee Donor Services. We also maximize the gift of life through the DCI Donor Services Tissue Bank and Sierra Donor Services Eye Bank. Our performance is measured by the way we serve donor families and recipients. To be successful in this endeavor is our ultimate mission. By mobilizing the power of people and the potential of technology, we are honored to extend the reach of each donor's gift and share the importance of the gift of life. With the help of our employee-led strategy team, we will ensure that all communities feel welcome and safe with us because we are a model for fairness, belonging, and forward thinking. This is a remote position Key responsibilities this position will perform include: Receives, compiles, and prepares the donor record for eligibility review and Medical Director signoff of donor records. Meets with the Medical Director(s) to review and answer questions pertaining to the information and documentation within the donor record. Participates in required quality training and educational growth to ensure staff is competent, compliant, and trained in quality related tasks with all regulatory and accreditation entities and internal DCIDS standards. Enters donor information (e.g. serology results) in computerized record systems. Answers donor recovery screening questions, on an on-call basis, as needed. Enters donor information (i.e. serology results) and utilizes quality management system in electronic system including, but not limited to, Q-Pulse, and PolicyTech. Acts as a role model for DCIDS and the DCIDS Quality Departments by supporting, reinforcing, and exhibiting behaviors consistent with the DCIDS core values; selfless, hardworking, passionate, and dependable. Performs final archive for all donor records. Performs other related duties as assigned. The ideal candidate will have the following attributes: Ability to communicate internally and externally to diverse audiences, with knowledge, tact, courtesy, and superior attention to detail. High School Diploma or Equivalent - Bachelor's Degree preferred. Two (2) years of healthcare experience. We offer a competitive compensation package including: Up to 184 hours of PTO your first year Up to 72 hours of Sick Time your first year Two Medical Plans (your choice of a PPO or HDHP), Dental, and Vision Coverage 403(b) plan with matching contribution Company provided term life, AD&D, and long-term disability insurance Wellness Program Supplemental insurance benefits such as accident coverage and short-term disability Discounts on home/auto/renter/pet insurance Cell phone discounts through Verizon **New employees must have their first dose of the COVID-19 vaccine by their potential start date or be able to supply proof of vaccination.** You will receive a confirmation e-mail upon successful submission of your application. The next step of the selection process will be to complete a video screening. Instructions to complete the video screening will be contained in the confirmation e-mail. Please note - you must complete the video screening within 5 days from submission of your application to be considered for the position. DCIDS is an EOE/AA employer - M/F/Vet/Disability.

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 searching for an experienced, motivating, and driven clinical leader to join our team as a Group Medical Director! This is a remote position overseeing multiple hospital locations within our Central Division. The Group Medical Director (GMD) has medical oversight of multiple markets within the organization with combined revenues of approximately $100MM or greater. 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 For additional details or questions, please email *********************************. 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.

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

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.

**About Otsuka** We defy limitation, so that others can too. In going above and beyond-under any circumstances-for patients, families, providers, and for each other. It's this deep-rooted dedication that drives us to uncover answers to complex, underserved medical needs, so that patients can push past the limitations of their disease and achieve more than they thought was possible each day. **About the Role** The Omnichannel Center of Excellence is dedicated to driving innovation, building, and delivering capabilities that enhance Otsuka's opportunity to make an impact in the lives of those we serve. We achieve this through our relentless focus on customer centricity, patient empathy, expertise in enabling pathways for disease education and awareness of management options, and our unwavering commitment to supporting access to treatment. We are looking for an **Omnichannel Data Scientist** , **Medical Omnichannel** with strong expertise in artificial intelligence, encompassing machine learning, data mining, and information retrieval. This position specifically entails the conceptualization, prototyping and development of next generation advanced analytics model-based decision engines and services. The ideal candidate will engage closely with key stakeholders to understand strategic objectives and leverage advanced data analytics and machine learning techniques to enhance communication strategies, ensuring seamless and personalized interactions with healthcare professionals (HCPs) and key opinion leaders (KOLs). **Job Expectations/Responsibilities:** **Data Integration & Management** + Explore and analyze common pharmaceuticals data (e.g., claims) as well as novel data sets based on lab and EHR systems. Work with Omnichannel Data Engineer to Integrate data from multiple sources (e.g., CRM systems, social media, email platforms) to create a unified view of stakeholder interactions. + Apply natural language processing (NLP) to extract insights from unstructured medical texts, such as clinical notes or call center transcripts. + Identifying relevant data drivers (features) that can inform decision making closely tied with strategy and creating visualizations to help communicate findings. **Advanced Analytics & Modeling** + Implement advanced analytics models, including predictive analytics and clustering algorithms, to generate actionable insights and track trends across various channels. + Work with Omnichannel ML/Ops engineer to build, test, and deploy production-grade predictive models and algorithms as part of the Omnichannel COE decision engine to meet business needs, including optimization of sales activities and predicting drivers of customer behavior. + Create repeatable, interpretable, dynamic, and scalable models that are seamlessly incorporated into analytic data products and match the needs of Otsuka's growing portfolio. + Collaborate on MLOPS life cycle experience with MLOPS workflows traceability and versioning of datasets. Build and maintain familiarity with Otsuka Machine Learning tech stack including AWS, Kubernetes, Snowflake, and Dataiku **Omnichannel Optimization** + Design and deploy recommendation systems to tailor communications based on stakeholder preferences and behaviors. Utilize machine learning algorithms (e.g., collaborative filtering, content-based filtering) to enhance personalization efforts. + Analyze the performance of omnichannel campaigns (email, SMS, in-app, HCP portals, etc.) to identify high-impact touchpoints and optimize engagement strategies. Use A/B testing and uplift modeling to evaluate the effectiveness of different communication strategies and content types. **Stakeholder Collaboration** + Effectively communicating analytical approach to address strategic objectives to business partners. + Work closely with medical affairs, marketing, and IT teams to ensure alignment and integration of omnichannel strategies. Provide technical guidance and support to cross-functional teams on data-related projects. + Stay updated with emerging industrial trends (Conferences and community engagement) and develop strategic industry partnerships on Omnichannel analytics to strengthen Otsuka's analytical methods and outcomes. + Model Otsuka's core competencies (Accountability for Results, Strategic Thinking & Problem Solving, Patient & Customer Centricity, Impact Communications, Respectful Collaboration & Empowered Development) that define how we work together at Otsuka. Key matrixed partners included: Brand Marketing, Creative / CRM / Digital agencies, Media, Market Research, Analytics, Otsuka Information Technology (OIT), Sales Operations, and Medical/Regulatory/Legal integrated business partners. **Minimum Qualification:** + Bachelor's degree in data sciences, computer science and 4-6 years of relevant experience **Preferred Knowledge, Skills, and Abilities:** + Demonstrated experience with scripting and implementing data analytics algorithms and models. Hands on experience using a modeling and simulation software (e.g. Python, Matlab, R, NONMEM, SAS, S-Plus, etc.) is a plus. + Knowledge/Experience in the usage of machine learning/AI tools in life science area(s) and handling life science datasets is preferred. + Excellent interpersonal, technical, and communication skills to lead cross-functional teams. + Profound grasp of Machine Learning lifecycle - feature engineering, training, validation, scaling, deployment, scoring, monitoring, and feedback loop. + Have implemented machine learning projects from initiation through completion with particular focus on automated deployment and ensuring optimized performance. + Agile skills and experience + Experience in Healthcare (esp. US) industry is a plus. **Competencies** **Accountability for Results -** Stay focused on key strategic objectives, be accountable for high standards of performance, and take an active role in leading change. **Strategic Thinking & Problem Solving -** Make decisions considering the long-term impact to customers, patients, employees, and the business. **Patient & Customer Centricity -** Maintain an ongoing focus on the needs of our customers and/or key stakeholders. **Impactful Communication -** Communicate with logic, clarity, and respect. Influence at all levels to achieve the best results for Otsuka. **Respectful Collaboration -** Seek and value others' perspectives and strive for diverse partnerships to enhance work toward common goals. **Empowered Development -** Play an active role in professional development as a business imperative. Minimum $164,530.00 - Maximum $245,985.00, plus incentive opportunity: The range shown represents a typical pay range or starting pay for individuals who are hired in the role to perform in the United States. Other elements may be used to determine actual pay such as the candidate's job experience, specific skills, and comparison to internal incumbents currently in role. Typically, actual pay will be positioned within the established range, rather than at its minimum or maximum. This information is provided to applicants in accordance with states and local laws. **Application Deadline** : This will be posted for a minimum of 5 business days. **Company benefits:** Comprehensive medical, dental, vision, prescription drug coverage, company provided basic life, accidental death & dismemberment, short-term and long-term disability insurance, tuition reimbursement, student loan assistance, a generous 401(k) match, flexible time off, paid holidays, and paid leave programs as well as other company provided benefits. Come discover more about Otsuka and our benefit offerings; ********************************************* . **Disclaimer:** This job description is intended to describe the general nature and level of the work being performed by the people assigned to this position. It is not intended to include every job duty and responsibility specific to the position. Otsuka reserves the right to amend and change responsibilities to meet business and organizational needs as necessary. Otsuka is an equal opportunity employer. All qualified applicants are encouraged to apply and will be given consideration for employment without regard to race, color, sex, gender identity or gender expression, sexual orientation, age, disability, religion, national origin, veteran status, marital status, or any other legally protected characteristic. If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation, if you are unable or limited in your ability to apply to this job opening as a result of your disability. You can request reasonable accommodations by contacting Accommodation Request (EEAccommodations@otsuka-us.com) . **Statement Regarding Job Recruiting Fraud Scams** At Otsuka we take security and protection of your personal information very seriously. Please be aware individuals may approach you and falsely present themselves as our employees or representatives. They may use this false pretense to try to gain access to your personal information or acquire money from you by offering fictitious employment opportunities purportedly on our behalf. Please understand, Otsuka will **never** ask for financial information of any kind or for payment of money during the job application process. We do not require any financial, credit card or bank account information and/or any payment of any kind to be considered for employment. We will also not offer you money to buy equipment, software, or for any other purpose during the job application process. If you are being asked to pay or offered money for equipment fees or some other application processing fee, even if claimed you will be reimbursed, this is not Otsuka. These claims are fraudulent and you are strongly advised to exercise caution when you receive such an offer of employment. Otsuka will also never ask you to download a third-party application in order to communicate about a legitimate job opportunity. Scammers may also send offers or claims from a fake email address or from Yahoo, Gmail, Hotmail, etc, and not from an official Otsuka email address. Please take extra caution while examining such an email address, as the scammers may misspell an official Otsuka email address and use a slightly modified version duplicating letters. To ensure that you are communicating about a legitimate job opportunity at Otsuka, please only deal directly with Otsuka through its official Otsuka Career website ******************************************************* . Otsuka will not be held liable or responsible for any claims, losses, damages or expenses resulting from job recruiting scams. If you suspect a position is fraudulent, please contact Otsuka's call center at: ************. If you believe you are the victim of fraud resulting from a job recruiting scam, please contact the FBI through the Internet Crime Complaint Center at: ******************* , or your local authorities. Otsuka America Pharmaceutical Inc., Otsuka Pharmaceutical Development & Commercialization, Inc., and Otsuka Precision Health, Inc. ("Otsuka") does not accept unsolicited assistance from search firms for employment opportunities. All CVs/resumes submitted by search firms to any Otsuka employee directly or through Otsuka's application portal without a valid written search agreement in place for the position will be considered Otsuka's sole property. No fee will be paid if a candidate is hired by Otsuka as a result of an agency referral where no pre-existing agreement is in place. Where agency agreements are in place, introductions are position specific. Please, no phone calls or emails.

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 Health Plan Holding Company, Inc. 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 is an exciting place to be within the healthcare industry. As a member of Mass General Brigham, we are on the forefront of transformation with one of the world's leading integrated healthcare systems. Together, we are providing our members with innovative solutions centered on their health needs to expand access to seamless and affordable care and coverage. Our work centers on creating an exceptional member experience - a commitment that starts with our employees. Working with some of the most accomplished professionals in healthcare today, our employees have opportunities to learn and contribute expertise within a consciously inclusive environment where diversity is celebrated. We are pleased to offer competitive salaries, and a benefits package with flexible work options, career growth opportunities, and much more. Under the direction of the Senior Medical Director, the Medical Director leads as a senior physician at the health plan. This position works closely with the Senior Medical Director in providing medical management leadership for clinical services operations and programs. This role focuses on and has expertise in utilization management, health plan quality and accreditation, care management, and other health plan functions. Qualifications Licensure and Credentials: Must maintain an active full physician license in Massachusetts Experience: * 3-5 years of Health Plan experience * at least 5 years of clinical practice experience Job Duties: 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 * Reviews clinical services and quality incidents when sufficiently serious to merit physician involvement * Coverage of medical necessity determinations to support special investigations/fraud waste and abuse cases * Collaborates on health plan medical policy development * Assesses new, emerging, and existing technologies to determine appropriateness of health plan coverage * Partners with clinical leaders to ensure medical service expenditures remain within budget * Collaborates with business development, quality, finance and medical management teams to promote improvements in the quality and cost efficiency of care throughout the MGB Health Plan provider network * Delivers consultation to network management staff and deployment of education programs for network clinicians * Develops and delivers presentations for clinical staff on current topics relevant to MGB Health Plan members and network * May represent MGB Health Plan at a variety of external forums and committees * Interact, communicate and collaborate with network and community physicians, hospital leaders and other vendors regarding care and services for enrollees * Monitors performance metrics and audits to identify areas for continuous improvement and ensure compliance * Anticipates and meets or exceeds internal and/or external customer expectations and requirements; establishes and maintains positive relationships with customers and gains their trust and respect * Build strong relationships and infrastructure that designate MGB Health Plan as a people-first organization * 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, exempt * In person meetings as requested for business needs * Participates in after hours and weekend call rotation as assigned Remote Type Remote Work Location 399 Revolution Drive Scheduled Weekly Hours 40 Employee Type Regular Work Shift Day (United States of America) EEO Statement: Mass General Brigham Health Plan Holding Company, Inc. 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.