Medical director jobs in Baton Rouge, LA - 101 jobs

**Your Future Evolves Here** Evolent partners with health plans and providers to achieve better outcomes for people with most complex and costly health conditions. Working across specialties and primary care, we seek to connect the pieces of fragmented health care system and ensure people get the same level of care and compassion we would want for our loved ones. Evolent employees enjoy work/life balance, the flexibility to suit their work to their lives, and autonomy they need to get things done. We believe that people do their best work when they're supported to live their best lives, and when they feel welcome to bring their whole selves to work. That's one reason why diversity and inclusion are core to our business. Join Evolent for the mission. Stay for the culture. **What You'll Be Doing:** As a Field Medical Director, MSK Surgery you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in patients' lives, in a non-clinical environment. You can enjoy better work- life balance on a team that values collaboration and continuous learning while providing better health outcomes. Collaboration Opportunities: + Routinely interacts with leadership and management staff, other Physicians, and staff whenever a physician`s input is needed or required. What You Will Be Doing: + Serve as the Physician match reviewer in Hip/Knee/Shoulder Surgery cases, that do not initially meet the applicable medical necessity guidelines, as well as other imaging requests when providers, clients, or state laws require specialty reviews to be completed by the subject matter expert. + Discusses determinations (peer to peer phone calls) with requesting physicians or ordering providers, when available, within the regulatory timeframe of the request and provides clinical rationale for standard and expedited appeals. + Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD review process to reflect appropriate utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance (NCQA) guidelines. + Aids and acts as a resource to Initial Clinical Reviewers. + Ensures documentation of all communications with medical office staff and/or MD provider is recorded in a timely and accurate manner. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. + Participates in on-going training per inter-rater reliability process. Qualifications: + MD/DO/MBBS + Minimum of five (5) years' experience in the practice of Medicine, post residency and Active Clinical practice within the last 2 years is highly preferred + Current, unrestricted clinical license in medicine or required specialty + Obtaining and maintaining medical licenses in the state you reside, as well as, any license required per business needs + Active Board Certification in Orthopedic Surgery + Strong clinical, management, communication, and organizational skills + Energetic and curious with a passion for quality and value in health care + Computer Proficiency + Not under current exclusion or sanction by any state or federal health care program, including Medicare or Medicaid, and is not identified as an "excluded person" by the Office of Inspector General of the Department of Health and Human Services or the General Service Administration (GSA), or reprimanded or sanctioned by Medicare. + No history of a major disciplinary or legal action by a state medical board To ensure a secure hiring process we have implemented several identity verification steps, including submission of a government issued photo ID. We conduct identity verification during interviews, and final interviews may require onsite attendance. All candidates must complete a comprehensive background check, in-person I-9 verification, and may be subject to drug screening prior to employment. The use of artificial intelligence tools during interviews is prohibited and monitored. Misrepresentation will result in immediate disqualification from consideration. **Technical Requirements:** We require that all employees have the following technical capability at their home: High speed internet over 10 Mbps and, specifically for all call center employees, the ability to plug in directly to the home internet router. These at-home technical requirements are subject to change with any scheduled re-opening of our office locations. **Evolent is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, or disability status.** **If you need reasonable accommodation to access the information provided on this website, please contact** ************************** **for further assistance.** The expected base salary/wage range for this position is $130-$150/hr. This position is also eligible for a bonus component that would be dependent on pre-defined performance factors. As part of our total compensation package, Evolent is proud to offer comprehensive benefits (including health insurance benefits) to qualifying employees. All compensation determinations are based on the skills and experience required for the position and commensurate with experience of selected individuals, which may vary above and below the stated amounts. Don't see the dream job you are looking for? Drop off your contact information and resume and we will reach out to you if we find the perfect fit!

During the last five years, Parexel has participated in more than 1,000 Oncology and Hematology clinical projects. The range of services includes compound clinical development planning, collaboration with feasibility, protocol writing or optimization, medical monitoring and pharmacovigilance. Parexel has global presence in every phase of clinical research and expertise in virtually every indication and mechanism of action, including novel Immuno-oncology agents, cellular based therapy, and cancer stem cell targeted treatment. Join our growing team of Oncologists/Hematologists and make a difference in the lives of patients searching for more effective and better tolerated cancer therapies. **Parexel's continued success has positioned us for significant North American growth in the coming year. As we prepare for this expansion, we're seeking to connect with Board-Certified Oncologists who are passionate about advancing clinical research and interested in learning more about the Medical Director role.** As a **Medical Director** at Parexel, you will provide medical monitoring for assigned projects, function as medical representative on the project team, provide medical consultation as required or requested to client/sponsor or to other Parexel service groups, and assume the role of Senior Technical Lead in selected circumstances. **In addition, you will also:** + Review all individual adverse experience reports for accuracy and clinical importance, and characterize their relationship to the study drug, severity and seriousness. + Provide reports to FDA or other regulatory agencies and the sponsor on a periodic and regular basis, summarizing adverse experiences as required by FDA or the sponsor, depending on the contract. + Review data listings of safety data, including adverse experiences, laboratory data, and vital signs data, to establish the presence or absence of abnormal trends, and if noted, follow up as appropriate with the project team, sponsor, investigator, and FDA. + Review documents written by various Parexel divisions for safety issues. + Review coding of adverse events and concomitant medications for accuracy and consistency. + Provide support for the preparation of clinical protocols, integrated clinical and statistical summary reports, journal articles, and other documents for clients/sponsors or in conjunction with clients/sponsors and in conjunction with other Parexel divisions. + Attend and present material, as requested, at meetings within Parexel as well as extra-company external meetings and conferences Successful applicants will be medically qualified based on successful completion of training at an accredited medical school and be US or Canada Board-certified in Oncology with experience in adult or pediatric clinical patient care. Past experience as a Medical Monitor, Physician in Industry, or as a Clinical Trial Primary Investigator or Sub-Investigator is highly preferred. **Successful applicants will also have:** + Excellent interpersonal skills including the ability to interact well with sponsor/client counterparts. + Excellent time management skills + Excellent verbal and written medical communication skills + Excellent standard of written and spoken English + A flexible attitude with respect to work assignments and new learning + The ability to manage multiple and varied tasks with enthusiasm and prioritize workload with attention to detail. + A willingness to work in a matrix environment and to value the importance of teamwork. + The ability to travel 10% domestically and/or internationally as needed. \#LI-REMOTE EEO Disclaimer Parexel is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to legally protected status, which in the US includes race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.

The Medical Director, Rare Disease is a critical role responsible for shaping the strategic processes and planning for assets in across phases of development within the Rare Disease portfolio. This position manages the unique challenge of establishing an emerging portfolio, incorporating newly acquired assets, which requires significant scientific and strategic agility and a strong ability to balance competing priorities. This position reports directly to the Rare Disease Medical Business Unit (BU) Lead. **** **Key Responsibilities Include:** **Medical Strategy & Narrative** + Provide key medical input into the initial development of the Target Reimbursable Product Profile as well as early development plans ensuring scientific consistency and alignment across functions (e.g., R&D, Clinical, Global Medical Affairs) + Provide high-quality scientific/clinical input and review of early asset plans, ensuring content aligns with the overarching Medical Narrative + Lead and nurture strategic partnerships with stakeholders by ensuring clear, consistent communication and aligning initiatives with partner priorities to strengthen collaboration and drive shared success in the rare disease space + Serve as a primary scientific resource, providing guidance on the disease state and mechanism of action for the Rare Disease portfolio helping to translate science into value for patients and stakeholders + Lead the Strategy and Tactical Planning Process, identifying critical data needs for the emerging portfolio **Evidence Generation Process** + Oversee the Medical Evidence Generation Process in partnership with GIE&I, translating strategic data gaps into clear research priorities and providing expert input into the design and feasibility of innovative clinical trials and data generation initiatives + Support the planning and execution of Medical Affairs evidence generation activities relevant to the Rare Disease portfolio **External Stakeholder Engagement** + Identify and engage a wide variety of stakeholders, including KOL experts and patient advocacy groups to support collection, curation and communication of clinical Medical and methodological insights to inform understanding of unmet medical needs, emerging standard of care and development opportunities + Develop Key Intelligence Topics & Questions (KITs/KIQs) for relevant assets, serving as the blueprint for insight collection from Key Opinion Leaders + Lead the strategic planning, content development, and successful facilitation of consulting activities including Advisory Boards, ensuring objectives align with data gap analyses and asset/portfolio strategy + Lead scientific exchange with key opinion leaders (KOLs) to gather insights and validate development hypotheses + Support the development of scientific publications, abstracts, and presentations related to the Rare Disease portfolio **Cross-functional Integration & Planning** + Collaborate within the Rare Disease Medical Business Unit with the Rare Disease Medical Communications and Field Medical Affairs sub-teams + Partner with and serve as a scientific and clinical resource for cross-functional colleagues including Clinical Development, Global Integrated Evidence & Innovation, Regulatory and Global Marketing and Market Access + Support indication prioritization and portfolio planning for early assets + Manage assigned Rare Disease medical program budgets in partnership with the Rare Disease Medical BU lead, ensuring accurate forecasting, responsible resource utilization, and compliance with internal policies and external regulations + Consider technology and AI to support workflow improvement **Qualifications** **Education and Experience:** + Advanced scientific degree is required (PharmD, MD, PhD, or equivalent) with extensive expertise in Rare Disease + Minimum of 5+ years of relevant experience in the pharmaceutical industry, with strong preference for experience in Clinical Development, Research, or Medical Affairs + Experience supporting BD evaluations for potential acquisitions + Experience contributing to the integration and strategic planning for newly acquired or in-licensed assets + Proven experience managing Evidence Generation processes and executing scientific Advisory Boards **Skills and Competencies:** + Strong leadership presence and ability to present to executive leadership team + Skilled in cultivating strong relationships with global medical partners through proactive communication and strategic prioritization + Motivated and solution-oriented with the ability to work collaboratively across the organization, particularly with R&D and Clinical teams + Strategic agility required to build and adapt scientific strategy for an emerging portfolio + Excellent communication and interpersonal skills, including experience presenting complex development strategies to large internal groups and engaging a limited number of highly specialized external experts + Full understanding of rules and regulations in pharma, with the ability to apply knowledge of guidelines and regulations to early-stage Medical Affairs activities + Ability to work in a fast-paced, dynamic environment, with a proactive and problem-solving mindset + Strong understanding of drug development processes, especially early-stage development + Openness to travel up to ~25% for 3 - 6 conferences in US and globally **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 $209,599.00 - Maximum $313,375.00, 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.

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. **We're Hiring: Full-time Behavioral Health Medical Director** Centene Corporation is a leading provider of government-sponsored healthcare coverage, providing access to affordable, high-quality services to Medicaid and Medicare members, as well as to individuals and families served by the Health Insurance Marketplace. Looking for a compelling opportunity to move beyond patient encounters and drive meaningful change in the community? **Qualifications for this role include:** + Must be licensed in Louisiana + Board certification by the American Board of Psychiatry and Neurology + 5+ years of post-residency experience **Position Purpose:** Assist the Sr Medical Director to direct and coordinate the medical management, quality improvement and credentialing functions for the business unit. + Provides medical leadership of all for utilization management, cost containment, and medical quality improvement activities. + Performs medical review activities pertaining to utilization review, quality assurance, and medical review of complex, controversial, or experimental medical services, ensuring timely and quality decision making. + Supports effective implementation of performance improvement initiatives for capitated providers. + Assists Sr Medical Director in planning and establishing goals and policies to improve quality and cost-effectiveness of care and service for members. + Provides medical expertise in the operation of approved quality improvement and utilization management programs in accordance with regulatory, state, corporate, and accreditation requirements. + Assists the Sr Medical Director in the functioning of the physician committees including committee structure, processes, and membership. + Conduct regular rounds to assess and coordinate care for high-risk patients, collaborating with care management teams to optimize outcomes. + Collaborates effectively with clinical teams, network providers, appeals team, medical and pharmacy consultants for reviewing complex cases and medical necessity appeals. + Participates in provider network development and new market expansion as appropriate. + Assists in the development and implementation of physician education with respect to clinical issues and policies. + Identifies utilization review studies and evaluates adverse trends in utilization of medical services, unusual provider practice patterns, and adequacy of benefit/payment components. + Identifies clinical quality improvement studies to assist in reducing unwarranted variation in clinical practice in order to improve the quality and cost of care. + Interfaces with physicians and other providers in order to facilitate implementation of recommendations to providers that would improve utilization and health care quality. + Reviews claims involving complex, controversial, or unusual or new services in order to determine medical necessity and appropriate payment. + Develops alliances with the provider community through the development and implementation of the medical management programs. + As needed, may represent the business unit before various publics both locally and nationally on medical philosophy, policies, and related issues. + Represents the business unit at appropriate state committees and other ad hoc committees. + May be required to work weekends and holidays in support of business operations, as needed. + Performs other duties as assigned + Complies with all policies and standards **Education/Experience:** + Medical Doctor or Doctor of Osteopathy. + Utilization Management experience and knowledge of quality accreditation standards preferred. + Actively practices medicine. + Course work in the areas of Health Administration, Health Financing, Insurance, and/or Personnel Management is advantageous. + Experience treating or managing care for a culturally diverse population preferred. **License/Certifications:** + Board certification by the American Board of Psychiatry and Neurology. + Current Louisiana state license as a MD or DO without restrictions, limitations, or sanctions from government programs. Pay Range: $221,300.00 - $420,500.00 per year Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

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. To enable this, we provide: + Award-winning culture + Inclusion and diversity as a priority + Performance Based Incentive Plans + Competitive benefits package that includes: Health, Vision, Dental, Short & Long-Term Disability + Generous PTO (including paid time to volunteer!) + Up to 9.5% 401(k) employer contribution + Mental health support + Career advancement opportunities + Student loan repayment options + Tuition reimbursement + Flexible work environments **_*All the benefits listed above are subject to the terms of their individual Plans_** **.** And that's just the beginning... With 10,000 employees helping more than 39 million people worldwide, every role at Unum is meaningful and impacts the lives of our customers. Whether you're directly supporting a growing family, or developing online tools to help navigate a difficult loss, customers are counting on the combined talents of our entire team. Help us help others, and join Team Unum today! **General Summary:** This position is responsible for providing expert medical analysis of claims files (or underwriting applications) across Unum US product lines. The incumbent provides high quality, timely, and efficient medical consultative services to the Benefits Center. The Medical Consultant adheres to current regulatory, claim process, and internal workflow standards as set forth in the Benefits Center Claims Manual, underwriting manual, and associated documentation. The incumbent adheres to accepted norms of medical practices and Code of Conduct guidelines. Physicians and psychologists conduct their reviews and analyses within appropriate ethical standards and maintain their professional licenses and Board certifications. This role is expected to provide excellent customer service and to interact on a regular basis with business partners, health care providers, and other specialized resources. **Principal Duties and Responsibilities** + Provide timely, clear medical direction and opinions to team partners, with reasoned forensic analysis to support the medical opinions + Partner/consult with fellow medical consultants when appropriate to ensure the completion of a whole person analysis + Apply medical knowledge to determine functional capacity through assessment of medical and other data related to impairment, regarding accuracy of diagnoses, treatment plans, duration guidelines, and prognosis + Provide relevant medical education and knowledge to others in terms appropriate and understandable to the intended audience + Perform telephone contacts with the insured's healthcare providers to gather medical information and to facilitate a better understanding of the claimant's functional abilities + Make timely and appropriate referrals for second opinion reviews when appropriate or required according to current guidelines and best practices + Demonstrate ability to manage and complete high volumes of assigned work, maintain consistently good turnaround times, and operate with a sense of urgency + Focus not only on individual workload, but on the team/group work volumes to ensure organizational success + Receive feedback and follow through with appropriate behaviors/actions + Perform other duties as assigned **Job Specifications** + Professional Degree (MD, DO, PhD, PsyD) + Active, unrestricted US medical license + Board certification required for physicians in their area of specialty + Minimum of five years of clinical experience in medical specialty + Strong team and collaborative skills. Ability to work in a fast paced, team based, corporate environment + Ability to mentor others and to give and receive constructive, behaviorally based feedback with peers and partners \#IN1 \#LI-RA1 Unum and Colonial Life are part of Unum Group, a Fortune 500 company and leading provider of employee benefits to companies worldwide. Headquartered in Chattanooga, TN, with international offices in Ireland, Poland and the UK, Unum also has significant operations in Portland, ME, and Baton Rouge, LA - plus over 35 US field offices. Colonial Life is headquartered in Columbia, SC, with over 40 field offices nationwide. Unum is an equal opportunity employer, considering all qualified applicants and employees for hiring, placement, and advancement, without regard to a person's race, color, religion, national origin, age, genetic information, military status, gender, sexual orientation, gender identity or expression, disability, or protected veteran status. The base salary range for applicants for this position is listed below. Unless actual salary is indicated above in the job description, actual pay will be based on skill, geographical location and experience. $133,500.00-$274,100.00 Additionally, Unum offers a portfolio of benefits and rewards that are competitive and comprehensive including healthcare benefits (health, vision, dental), insurance benefits (short & long-term disability), performance-based incentive plans, paid time off, and a 401(k) retirement plan with an employer match up to 5% and an additional 4.5% contribution whether you contribute to the plan or not. All benefits are subject to the terms and conditions of individual Plans. Company: Unum

Description & Requirements This federally funded initiative delivers medical readiness services - including physical exams, screenings, dental care, and preventative health - to military personnel in remote or underserved areas. Services are provided through a network of providers and mobile teams, ensuring consistent access to care and compliance with Department of Defense readiness standards. The Regional Medical Officer (RMO) Region 1 Northeast serves as the senior clinical leader overseeing medical readiness operations across a large and highly populated Northeast and Midwest corridor. This role supports a federally funded medical readiness initiative delivering physical exams, screenings, dental services, and preventative care to military personnel, including those in urban centers, remote locations, and underserved communities. Region 1 (Northeast) Coverage: ME, VT, NH, MA, RI, CT, NY, NJ, PA, DE, MD, DC, OH, IN, IL, MI, MO ***Please note that this position is contingent upon bid award*** Essential Duties and Responsibilities: - Serve as the regional clinical lead, overseeing medical readiness operations within assigned geographic area. - Coordinate and monitor delivery of services (physical exams, immunizations, dental screenings) to meet DoD readiness requirements. - Ensure compliance with federal regulations, HIPAA, and program protocols. - Collaborate with chief medical officer, clinicians, mobile teams, subcontractors, and scheduling units to optimize service delivery. - Provide clinical oversight, review documentation, and address escalated medical concerns. - Support credentialing, audits, quality assurance reviews, and reporting requirements for federal stakeholders. - Act as a liaison between program leadership and regional providers to maintain operational efficiency and quality of care. Minimum Requirements - Doctor of Medicine (MD) or Doctor of Osteopathy (DO) from an accredited institution. - Active, unrestricted medical license in the U.S. - 5+ years of clinical experience, preferably in occupational health, preventive medicine, or military readiness programs. Additional Minimum Requirements: - Ability to travel frequently within the assigned region, including weekend overnight stays, to support mobile or remote readiness events. - Experience supporting DoD or federal healthcare programs. - Familiarity with medical readiness requirements and electronic health record systems. (Preferred) - Leadership experience managing dispersed clinical teams. (Preferred) - Specialty in Primary Care, Occupational Medicine, Pediatrics, or Preventative Medicine. (Preferred) Region 1 Coverage: ME, VT, NH, MA, RI, CT, NY, NJ, PA, DE, MD, DC, OH, IN, IL, MI, MO #LI-AM1 #maxcorp #HotJobs1230LI #HotJobs1230FB #HotJobs1230X #HotJobs1230TH #TrendingJobs #c0rejobs #HotJobs0106LI #HotJobs0106FB #HotJobs0106X #HotJobs0106TH #HotJobs0113LI #HotJobs0113FB #HotJobs0113X #HotJobs0113TH #c0rejobs EEO Statement Maximus is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, age, national origin, disability, veteran status, genetic information and other legally protected characteristics. Pay Transparency Maximus compensation is based on various factors including but not limited to job location, a candidate's education, training, experience, expected quality and quantity of work, required travel (if any), external market and internal value analysis including seniority and merit systems, as well as internal pay alignment. Annual salary is just one component of Maximus's total compensation package. Other rewards may include short- and long-term incentives as well as program-specific awards. Additionally, Maximus provides a variety of benefits to employees, including health insurance coverage, life and disability insurance, a retirement savings plan, paid holidays and paid time off. Compensation ranges may differ based on contract value but will be commensurate with job duties and relevant work experience. An applicant's salary history will not be used in determining compensation. Maximus will comply with regulatory minimum wage rates and exempt salary thresholds in all instances. Accommodations Maximus provides reasonable accommodations to individuals requiring assistance during any phase of the employment process due to a disability, medical condition, or physical or mental impairment. If you require assistance at any stage of the employment process-including accessing job postings, completing assessments, or participating in interviews,-please contact People Operations at **************************. Minimum Salary $ 199,920.00 Maximum Salary $ 270,480.00

**_What Finance Operations contributes to Cardinal Health_** Finance oversees the accounting, tax, financial plans and policies of the organization, establishes and maintains fiscal controls, prepares and interprets financial reports, oversees financial systems and safeguards the organization's assets. Finance Operations is responsible for core financial operation processes. This can include customer and vendor contract administration; customer and vendor pricing, rebates, billing vendor chargeback research and reconciliation; processing vendor invoices and employee expense reports for payment; fixed asset accounting for book and tax records; cash application; and journal entries. + Demonstrates knowledge of financial processes, accounting policies, systems, controls, and work streams + Demonstrates experience working in a transnational finance environment coupled with strong internal controls + Possesses understanding of service level goals and objectives when providing customer support + Works collaboratively to respond to non-standard requests + Possesses strong organizational skills and prioritizes getting the right things done **_Responsibilities_** + Manage a team of Cardinal Health and Genpact individuals who oversee the entirety of the GPO Admin Fees and Rebates set up and report creation functions, including P&L accruals, rebate setups within SAP Vistex and ad hoc reporting for key internal and external stakeholders. Responsible for the month end accounting close process. + Ensure GPO Admin Fees and Rebates are properly accounted for based on core accounting principles + Own first level review/approval responsibilities for non-standard rebate structures to ensure proper audit documentation is maintained and proper approvals are received + Oversee key rebate accuracy and timeliness CSLs and KPIs + Partner with cross-functional teams to research and resolve root cause issues impacting rebate accuracy or ability to set up Rebates and GPO Admin Fees timely; apply big picture knowledge to assess and interpret financial impact of process changes and resulting driver outcomes of GPO Admin Fee/Rebate set up changes + Foster a strong SOX internal control structure and seek opportunities for improvements, including build out of SOP processes and project development + Transform current payout and reporting process into Vistex implementation and go-forward build/upkeep + Develop plans for future systematic enhancements + Assist team with more complicated customer and transaction activities; oversee escalations to ensure closure in a timely manner + Partner with and be a thought-provoking leader to business partners across the organization to properly account for transactions, including but not limited to Sales, Legal, Finance, Pricing, Accounting and Contracting + Actively collaborate and support cross-functional team initiatives to improve customer experience, both internally and externally + Establish team and individual-oriented goals for growth and development **_Qualifications_** + Bachelor's Degree in Accounting, Finance or Business Management, preferred + CPA preferred + 8+ years of professional experience in related field, preferred, including Accounting, Finance, or Audit, preferred + Accounting and Finance acumen + Ability to lead a new team and influence others + Knowledge with SAP and legal contracts (revenue recognition standards is a plus) + Data mining experience (relevant application tool experience is a plus) + Strong written and verbal communication skills + Process improvement oriented + Strong SOX/internal control understanding **Anticipated salary range:** $105,100 - $135,090 **Bonus eligible:** Yes **Benefits:** Cardinal Health offers a wide variety of benefits and programs to support health and well-being. + Medical, dental and vision coverage + Paid time off plan + Health savings account (HSA) + 401k savings plan + Access to wages before pay day with my FlexPay + Flexible spending accounts (FSAs) + Short- and long-term disability coverage + Work-Life resources + Paid parental leave + Healthy lifestyle programs **Application window anticipated to close:** 1/16/2026 *if interested in opportunity, please submit application as soon as possible. The salary range listed is an estimate. Pay at Cardinal Health is determined by multiple factors including, but not limited to, a candidate's geographical location, relevant education, experience and skills and an evaluation of internal pay equity. _Candidates who are back-to-work, people with disabilities, without a college degree, and Veterans are encouraged to apply._ _Cardinal Health supports an inclusive workplace that values diversity of thought, experience and background. We celebrate the power of our differences to create better solutions for our customers by ensuring employees can be their authentic selves each day. Cardinal Health is an Equal_ _Opportunity/Affirmative_ _Action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, ancestry, age, physical or mental disability, sex, sexual orientation, gender identity/expression, pregnancy, veteran status, marital status, creed, status with regard to public assistance, genetic status or any other status protected by federal, state or local law._ _To read and review this privacy notice click_ here (***************************************************************************************************************************

**Become a part of our caring community and help us put health first** The Director Denials Management provides leadership for the audit, appeal and review process to preserve and recover revenue while maintaining the highest level of clinical and regulatory integrity and compliance. Manages the Denials Management data analytics, denial and appeal process. The Director, Home Health Grievances & Appeals assists members, via phone or face to face, further/support quality related goals. Investigates and resolves member and practitioner issues. Decisions are typically related to the implementation of new/updated programs or large-scale projects for the function and supporting technical/operational procedures and processes, and implements strategic plans, drives goals and objectives, and improves performance. Provides input into functions strategy. **Responsibilities:** + Oversee the process for direction and support to clinical and operational leadership regarding Medicare and governmental audit trends, denials, and any CMS initiative and/or demonstration projects. + Collaborates with leadership team in the development of an education plan to improve processes to preserve and recover revenue. + Analyzes region-wide outcome indicators to measure achievement of quantitative and qualitative standards. Assists in the development, implementation and analysis of internal and external benchmarking programs to measure the region's effectiveness in improving performance + Maintains region-wide Performance Improvement program which includes Customer Satisfaction, complaints, infection monitoring, Incident Reporting, and quarterly branch PI activity + Provides feedback and recommendations for changes to policies and processes, procedures and systems to enhance measures taken to improve performance + Communicate with Corporate leadership, Regional and Divisional leaders as appropriate to resolve issues that may place patients or the company at risk + Oversee educational in-services based on analysis of PI data and activities Acts as a resource for the Operations Support team and communicates Performance Improvement results + Participate in special projects and performs other duties as assigned. **Use your skills to make an impact** **Required Qualifications** + Bachelor's degree in Nursing or related field + 10-15 years progressively responsible experience in home health or hospice industry that includes performance improvement and outcomes measurement + 5 years' experience in a supervisory or teaching role + Thorough knowledge of health care policy, industry and related clinical practice + Knowledge in the interpretation and application of regulations and performance improvement standards + Strong Project management principles and clinical policy development/implementation required + Expert knowledge of all Medicare regulations and appeals processes + Excellent analytical skills with ability to interpret and apply regulatory requirements + Excellent verbal/written communication and presentation skills + Advanced knowledge with Payer requirements, ADR requests, Denials, Appeals, RAC/ZPIC and CERT responses + Must be able to work well independently and in a team environment + Excellent communication and organization skills + Strong attention to detail + Healthcare industry experience preferred + Must read, write and speak fluent English + Must have good and regular attendance + Approximate percent of time required to travel: 30% + Performs other related duties as assigned **Preferred Qualifications** + Master's Degree preferred + Licenses/Certification: RN, PT or OT preferred + More than 3 years of grievance and appeals experience + Strong knowledge in Microsoft Access or experience with SQL Server databases + Previous experience processing medical claims + Bilingual (English and Spanish); with the ability to read, write, and speak English and Spanish **Additional Information** **SSN Alert Statement** Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from ******************** with instructions on how to add the information into your official application on Humana's secure website. **Interview Format** As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule. **WAH Internet Statement** To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. Satellite, cellular and microwave connection can be used only if approved by leadership. Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information. Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. **Scheduled Weekly Hours** 40 **Pay Range** The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $126,300 - $173,700 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. **Description of Benefits** Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. Application Deadline: 01-30-2026 **About us** About CenterWell Home Health: CenterWell Home Health specializes in personalized, comprehensive home care for patients managing a chronic condition or recovering from injury, illness, surgery or hospitalization. Our care teams include nurses, physical therapists, occupational therapists, speech-language pathologists, home health aides, and medical social workers - all working together to help patients rehabilitate, recover and regain their independence so they can live healthier and happier lives. About CenterWell, a Humana company: CenterWell creates experiences that put patients at the center. As the nation's largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE: HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first - for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one. **Equal Opportunity Employer** It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Centerwell, a wholly owned subsidiary of Humana, complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our full accessibility rights information and language options *************************************************************

Lighthouse Lab Services has partnered with a large healthcare organization in the epicenter of Louisiana seeking a Director of Laboratory Services. This individual would be a part of their growing operation in Baton Rouge, LA. ABOUT BATON ROUGE, LA: Baton Rouge, Louisiana, blends Southern charm, cultural richness, and modern opportunity. With a cost of living well below national averages, residents enjoy affordable comfort and a vibrant lifestyle. The city's Cajun and Creole cuisine, lively music, and annual festivals celebrate its unique Louisiana heritage. Home to LSU and a growing research and technology hub, Baton Rouge offers strong professional and educational opportunities. From scenic riverfront trails to the energy of LSU game days, Baton Rouge is affordable, flavorful, and full of heart. It is a place where life moves to its own joyful rhythm. ABOUT THE CLIENT: For generations, the client has been a cornerstone of the community, adapting through historic advances in medicine, technology, and patient needs. The hospital has expanded access to care and simplified the healthcare experience, now offering more than 600 licensed beds across three campuses. From delivering newborns to providing compassionate hospice care, they deliver the full spectrum of healthcare services. Its acclaimed, award-winning cancer and heart programs, and network of clinics across the region reflect a steadfast commitment to comprehensive, patient-centered care for every stage of life. ABOUT THE ROLE: The Director of Laboratory Services is responsible for the overall operation and administration of the Laboratory including the employment of personnel who are competent to perform test procedures, record and report test results promptly and accurately and for assuring compliance with the applicable regulations. With oversight of strategic planning, direction and overall accountability all Laboratory Services, the Director of Laboratory Services independently makes decisions that could seriously affect the overall division and/or the hospitals financial and performance objectives and strategic results. They will actively participate in committees responsible for establishing related policies and procedures. They will develops oversee department budget, direct reports including managers, supervisors and staff to include responsibility for performance reviews, hiring, disciplinary actions and terminations. KEY RESPONSIBILITIES: Demonstrate courtesy and caring for each other, patients and their family, physicians, and the community. Take initiative in living our values and vital signs. Take initiative in identifying customer needs before the customer asks. Participate in teamwork willingly and with enthusiasm. Demonstrate respect for the dignity and privacy needs of customers through personal action and attention to the environment of care. Keep customers informed, answers customer questions and anticipate information needs of customers. Participate in Interdepartmental Rounding for the areas served. Practice diligence in fulfilling the regulatory and legal requirements of the position and department. Maintain accurate and reliable patient/organizational records. Maintain professional relationships with appropriate officials; communicate honesty and completely; behave in a fair and nondiscriminatory manner in all professional contacts. Set goals and action plans to achieve objectives. Complete assignments following accepted procedures and practices, even when workloads and demands are high. Adhere to high moral principles of honesty, loyalty, sincerity, and fairness (integrity). Utilize data to plan new products and services. Strive to continuously improve all aspects of the business operation through quality improvement initiatives. Assure the accuracy of data, work, or information and contributes ideas and suggestions to improve approaches, methodologies, and productivity. Utilize data to implement clinical and operational redesign efforts. Willingly participate in organization and/or department quality initiatives. Demonstrate effective time management to promote productivity and cost efficiency. Use material goods wisely, is conscious of the environment and is accountable for prudent use of our talents and financial resources. Develop appropriate budget(s) for areas of responsibility. Effectively manage budget(s) and continually monitor key cost areas. Invite input from others and share ownership and recognition. Inspire people by example and influence them to do and be their best. Inspirate and encourage teamwork. Consistently execute applicable company policies, rules and regulations. Establish clear work objectives that prioritize and focus on employee efforts. Staff work area with appropriate numbers of qualified employees. Allocate and delegate work effectively to make efficient use of resources and employee capabilities. Provide opportunities for skill development for employees. Delegate authority to supervisory and department(s) or areas of responsibility staff members. Provide direction and policy interpretation to managers. Encourage staff participation and communication in decision-making. Exhibit responsiveness to others in the organization at all levels. Assure that applicable accreditation standards and governmental regulations for areas of responsibility are continually met. Analyze services to determine means of improving efficiency, quality and cost effectiveness. Effectively plan the scope, emphasis and objectives of laboratory services. Effectively organize the Laboratory's operating systems. Effectively measure the performance and productivity of the department by means of quantitative profiling of factors such as procedures, and staff utilization. Establish and maintain communication with internal and external customers in order to ensure a timely response to new clinical service trends and program planning. Investigate and studies trends and developments in Laboratory practices and techniques. Actively participate in committees responsible for establishing related policies and procedures. Develop goals and objectives in consultation with Administration. Participate in space utilization/consolidation studies and analysis. Lead and direct the development, communication and implementation of effective growth strategies and processes. Develop recommended plans to maximize operational efficiencies. Demonstrate good planning in anticipating the replacement needs of Laboratory equipment. Knowledge of budget preparation and monitoring, and accreditation requirements. MINIMUM REQUIRED QUALIFICATIONS Bachelor's degree in medical technology, clinical laboratory, chemical, physical or biological science, or related field. Higher degree would be a plus. 5 years leadership level experience in Laboratory services preferred. MLS(ASCP) Certification preferred. Current Clinical Laboratory Scientist, Generalist, or Specialist license issued by the Louisiana State Board of Medical Examiners required. SHIFT, SALARY, BENEFITS: First shift M-F Salary starting in the $100Ks and depending on experience, education, etc Full, comprehensive benefits package. Generous PTO. Possible EOY performance based bonuses About Us: At Lighthouse Lab Services, we offer solutions to help start, grow, and run clinical laboratories. Our recruiting team has more than 22 years of proven success placing job seekers in positions ranging from entry-level Medical Technologists to seasoned Laboratory Directors. We recruit nationwide for permanent and travel positions with clients ranging from small hospitals to large reference laboratories. It is the policy of Lighthouse Lab Services to provide equal employment opportunity (EEO) to all persons regardless of age, color, national origin, citizenship status, physical or mental disability, race, religion, creed, gender, sex, sexual orientation, gender identity and/or expression, genetic information, marital status, status with regard to public assistance, veteran status, or any other characteristic protected by federal, state or local law. In addition, Lighthouse Lab Services will provide reasonable accommodations for qualified individuals with disabilities. Lighthouse Lab Services|************|lighthouselabservices.com #LLS3

Hospital Administrator needed to lead a well-established, financially stable and well reputed 24 beds Adult Acute Psychiatric Hospital Inpatient and Outpatient programs located in Baton Rouge, LA. Apollo Behavioral Health Hospital established in June 2012 and moved into a newly constructed facility in Aug 2018, is a state-of-the-art facility conveniently located in the heart of Baton Rouge at the intersection of I-12 and Airline Highway. Salary: Starting base $100,000+/yr - DOE plus growth opportunity up to $300,000 Benefits: Health, dental & vision insurance 401K plan and profit-sharing plan Holiday pay & PTO Competitive salary Positive work environment This position will be responsible for the overall operation of the facility's programs according to approved policies, procedures, and standards. Works in conjunction with the Medical Director, DON and CEO to ensure that quality patient care is provided according to state and federal laws and regulations. Maintains the image of the facility in the local communities and in state and national organizations. Keeps the facility abreast of local, state, and national trends. RESPONDSIBILITIES: Serves as the liaison among the governing body, the professional advisor group, and the professional and business staff. Responsible for overall operation of all programs at IPF and OPF. Employs qualified personnel and provides for adequate staff education. Interviews, hires, supervises, evaluates, and terminates administrative staff. Ensures adequacy of all staff. Interprets policies and procedures for the Board of Directors, including the implications of proposed policies. Ensures the implementation of all policies and procedures. Promotes good community relations through involvement in community affairs and serving on related boards and committees. Investigates and resolves all complaints. Monitors the fiscal condition of the facility and ensures adequate resources. Quarterly evaluation of each department functioning and leadership functioning. Identify Strengths and Weaknesses, Identify the non-compliance issues, Establish Goals and Measure of Success. Assist with the LDH/TJC survey process and write corrective action plans. Promote positive culture within the company and motivate staff to be productive and do the right thing that they are hired for. Pro-active approach to problem solving and taking measures to avoid the crisis. Keep the programs running at FULL capacity. Expand the bed capacity from 24 beds to 48 beds or higher. Expand the Outpatient service lines and census beyond the building capacity. EDUCATION/EXPERIENCE REQUIREMENTS: Must have the following qualifications: Must have a baccalaureate degree in health care administration, nursing, social work, mental health, or equivalent experience Must have a master's degree in Nursing/Social Work/Mental Health/Business Administration. Must have at least three years full-time experience in hospital administration preferably administrator at a psychiatric hospital. Must have at least five years of progressively responsible management position in healthcare. RN/NP/LCSW/MBA license preferred.

Job Description Hospital Administrator needed to lead a well-established, financially stable and well reputed 24 beds Adult Acute Psychiatric Hospital Inpatient and Outpatient programs located in Baton Rouge, LA. Apollo Behavioral Health Hospital established in June 2012 and moved into a newly constructed facility in Aug 2018, is a state-of-the-art facility conveniently located in the heart of Baton Rouge at the intersection of I-12 and Airline Highway. Salary: Starting base $100,000+/yr - DOE plus growth opportunity up to $300,000 Benefits: Health, dental & vision insurance 401K plan and profit-sharing plan Holiday pay & PTO Competitive salary Positive work environment This position will be responsible for the overall operation of the facility's programs according to approved policies, procedures, and standards. Works in conjunction with the Medical Director, DON and CEO to ensure that quality patient care is provided according to state and federal laws and regulations. Maintains the image of the facility in the local communities and in state and national organizations. Keeps the facility abreast of local, state, and national trends. RESPONDSIBILITIES: Serves as the liaison among the governing body, the professional advisor group, and the professional and business staff. Responsible for overall operation of all programs at IPF and OPF. Employs qualified personnel and provides for adequate staff education. Interviews, hires, supervises, evaluates, and terminates administrative staff. Ensures adequacy of all staff. Interprets policies and procedures for the Board of Directors, including the implications of proposed policies. Ensures the implementation of all policies and procedures. Promotes good community relations through involvement in community affairs and serving on related boards and committees. Investigates and resolves all complaints. Monitors the fiscal condition of the facility and ensures adequate resources. Quarterly evaluation of each department functioning and leadership functioning. Identify Strengths and Weaknesses, Identify the non-compliance issues, Establish Goals and Measure of Success. Assist with the LDH/TJC survey process and write corrective action plans. Promote positive culture within the company and motivate staff to be productive and do the right thing that they are hired for. Pro-active approach to problem solving and taking measures to avoid the crisis. Keep the programs running at FULL capacity. Expand the bed capacity from 24 beds to 48 beds or higher. Expand the Outpatient service lines and census beyond the building capacity. EDUCATION/EXPERIENCE REQUIREMENTS: Must have the following qualifications: Must have a baccalaureate degree in health care administration, nursing, social work, mental health, or equivalent experience Must have a master's degree in Nursing/Social Work/Mental Health/Business Administration. Must have at least three years full-time experience in hospital administration preferably administrator at a psychiatric hospital. Must have at least five years of progressively responsible management position in healthcare. RN/NP/LCSW/MBA license preferred.

Responsibilities will include oversight of hospital operations, financial management, and regulatory compliance. Leads the facility management staff and consultants in developing and working from a business plan that focuses on all aspects of facility operations, including setting priorities and job assignments. Monitors each department's activities, communicates policies, evaluates performance, provides feedback, and assists, observes, coaches and disciplines as needed. Oversees regular rounds to monitor delivery of nursing care, operation of support departments, cleanliness and appearance of the facility; moral of the staff; and ensures resident needs are being addressed. Develops positive relationships on behalf of the Company with government regulators, residents, families, area health care, physicians, and the community at large. Acts as a resource of information to the community related to health care issues. Exhibits positive customer service both to internal and external customers through the ongoing support and implementation of the Company's Health and Rehabilitation Services customer service initiatives and business objectives. Utilizes survey information to address areas of importance as defined by our customers. Ensures consultants and other support resources are appropriately utilized and a high level of interdepartmental teamwork is maintained. Maintain a working knowledge of and ensure compliance with all governmental regulations. Monitor Human Resources practices to ensure compliance with employment laws and company policies, and to ensure practices that maintain high morale and staff retention to include effective communication, prompt problem resolution, proactive supervisory practices, and maintaining a proactive work environment. Manage turnover and ensure current and future staffing through development of recruiting sources, and through appropriate selection, orientation, training, staff education and development. Develop and implement a marketing strategy for the facility that reflects service opportunities, competition, potential market area changes, and which maximizes census, payor mix, and ancillary revenues. Lead and monitor key staff and facility staff to play an active role in carrying out the marketing plan. Take initiative in evaluation, development and implementation of new business opportunities that meets the needs of the community and benefits the facility/Company. Comply with, support and enforce Company policies involving all safety and infection control procedures. Promote and understanding of and compliance with all rules regarding resident's rights; promote positive relationships with residents, visitors and regulators. Supervise, conduct and participate in department and facility education activities and staff meetings. Utilize the quality improvement process in all areas of facility operation. Qualifications Degree and/or experience in a Physical Therapy/Hospital/Nursing Home/Assisted Living Setting. Master's Degree preferred Five or more years of recent hospital therapy management and/or supervisory experience. Must have record of demonstrating leadership competencies and management style that exemplify clients values. Substantial knowledge of applicable State, Federal and local codes, regulations, laws and regulatory compliance process. Knowledge of current and emerging industry trends affecting health care and rehabilitation practice. Demonstrated excellent written and verbal communication skills, and leadership competencies. Must possess basic computer knowledge Keywords: Rehabilitation, Nursing, Speech Language Pathologist, Occupational Therapist, Physical Therapist, Case Management, Social Services. Additional Information All your information will be kept confidential according to EEO guidelines.

This role supports the Medical Policy team by bringing medical director level expertise, experience and knowledge to the team. They support the full-cycle ownership of commercial and Medicare Advantage medical policies, both developed internally and by vendors. This includes the writing of clinical criteria based on research, engagement of clinical and non-clinical team members for operational guidelines. The incumbent must have an understanding of medical coding (ICD-10, CPT, HCPS) as medical coding based off policy criteria falls within their scope. In addition to developing new policies, the incumbent ensures all existing medical policies, in their scope, are in accordance with NCQA and/or CMS requirements. The incumbent may be required to address escalated inquiries brought forward by internal/external partners. Conducts peer reviews as part of the quality review process. In addition to policy ownership, the incumbent participates in various work-groups and sub-committees as a clinical lead/expert. Trains and orients new staff to the department and policy procedures, and mentors new team members. Serves as a liaison between other departments and vendors as required. **ESSENTIAL RESPONSIBILITIES** + Full-cycle ownership of commercial and Medicare Advantage medical policy creation process including writing clinical criteria and oversight/ownership of the clinical presentations to committees for internally developed and vendor owned policies.Engage other departments, team members, strategic partners, and vendors to assist with research. + Provide clinical guidance to non-clinical team.This may include those who own Medicare Advantage policy updates, and those who support the commercial policy team. + Address escalated policy inquiries that require clinical expertise.This may include updating/revising existing medical policies. + Partner with Utilization Management and other operational teams to identify opportunities within medical policy. + Discover and cultivate innovative opportunities that drive significant improvements in healthcare quality and efficiency. + Other duties as assigned or requested. **EXPERIENCE** **Required** + 5 years of Active medical practice + 3 years of medical policy experience **Preferred** + 1 year of medical coding experience **SKILLS** + Critical Thinking + Oral and Written Communication + Listening + Telephone Skills + General Computer Skills, including Excel + Clinical Software + Email Software (Outlook) and Teams + MS Word + Managed Care **EDUCATION** **Required** + Doctor of Medicine or Doctor of Osteopathic Medicine **Substitutions** + None **Preferred** + None **LICENSES or CERTIFICATIONS** **Required** + Medical Doctor OR Doctor of Osteopathic Medicine (DO), Board certified in an American Board of Medical Specialties or Bureau of Osteopathic, Specialists recognized specialty credentialed in a Highmark network + Active medical state licensure required. Additional specific state licensure(s) may be required based on business need. **Preferred** + None **Language (Other than English):** + None **Travel Required:** + Less than 25% **PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS** **Position Type** + Office-Based or Remote Position **Physical work site required** + Never **_Disclaimer:_** _The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job._ **_Compliance Requirement_** _: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies._ _As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company's Handbook of Privacy Policies and Practices and Information Security Policy._ _Furthermore, it is every employee's responsibility to comply with the company's Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements._ **Pay Range Minimum:** $170,000.00 **Pay Range Maximum:** $352,500.00 _Base pay is determined by a variety of factors including a candidate's qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets._ Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law. We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below. For accommodation requests, please contact HR Services Online at ***************************** California Consumer Privacy Act Employees, Contractors, and Applicants Notice Req ID: J273814

**Parexel** is in the business of improving the world's health. We do this by providing a suite of biopharmaceutical services that help clients across the globe transform scientific discoveries into new treatments. From clinical trials to regulatory, consulting, and market access, our therapeutic, technical, and functional ability is underpinned by a deep conviction in what we do. We believe in our values, Patients First, Quality, Respect, Empowerment & Accountability. **Parexel is looking for a Medical Director with a very strong background in Ophthalmology to join our Global Medical Sciences team.** **The role is remotely based in the US.** The Medical Director is a medical expert with specialized therapeutic expertise and some experience across indications, clients and drug development. They initiate and maintain medical and consultative relationships with clients, consult on early engagement and pre-award efforts and serve as a medical monitor for contracted projects. The Medical Director may take on leadership roles by participating in initiatives, mentoring junior MDs and/or, where appropriate, managing a team of physicians. Primary activities will focus on **Medical Monitoring Delivery & PV Support** . The medical monitor will independently deliver all medical support required for successful delivery of the projects according to contracted agreement with the sponsor (i.e., tasks and time per task contracted) and according to the assigned role (Global Lead Physician or Regional Lead Physician). **Medical Expertise** and experience in **Ophthalmology** is essential to the medical monitor role and will be manifested in high quality consultation on protocol development or drug development programs, medical review of various documents, collaboration on internal therapeutic area meetings, training module development, white papers, slide sets, publications etc. **Client Relationship Building & Engagement,** including soliciting and addressing client feedback and suggestions regarding medical study-related activities, are core skills required of the medical monitor. **Business Development:** the medical monitor will provide medical expertise / leadership in Proposal Development Teams (PDTs) for client bid pursuit meetings. **Skills** + Excellent interpersonal skills including the ability to interact well with sponsor/client counterparts + Client-focused approach to work + Excellent time management skills + Excellent verbal and written medical communication skills + Excellent standard of written and spoken English + A flexible attitude with respect to work assignments and new learning + Ability to manage multiple and varied tasks with enthusiasm and prioritize workload with attention to detail + Willingness to work in a matrix environment and to value the importance of teamwork. **Knowledge And Experience** + Experience in clinical medicine (general or specialist qualifications) with Fellowship or specialty training in **Ophthalmology** , which is expected to be kept up to date. + A background in clinical aspects of drug development, including all aspects of Medical Monitoring and study design/execution, preferred + Clinical practice experience + Good knowledge of the drug development process including drug safety, preferred + Experience in Pharmaceutical Medicine, preferred + Experience leading, mentoring and managing individuals/ a team, preferred **Education** + US Board certified in **Ophthalmology** + Experience as a Physician in Industry or as a clinical trial investigator is required + Previous CRO experience is strongly preferred + Medically qualified in an acknowledged medical school with completion of at least basic training in clinical medicine (residency, internship) The ability to travel 15% domestically or internationally is required. \#LI-REMOTE EEO Disclaimer Parexel is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to legally protected status, which in the US includes race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.

**Your Future Evolves Here** Evolent partners with health plans and providers to achieve better outcomes for people with most complex and costly health conditions. Working across specialties and primary care, we seek to connect the pieces of fragmented health care system and ensure people get the same level of care and compassion we would want for our loved ones. Evolent employees enjoy work/life balance, the flexibility to suit their work to their lives, and autonomy they need to get things done. We believe that people do their best work when they're supported to live their best lives, and when they feel welcome to bring their whole selves to work. That's one reason why diversity and inclusion are core to our business. Join Evolent for the mission. Stay for the culture. **What You'll Be Doing:** As a Cardiology, Field Medical Director you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in patients lives, in a non-clinical environment. You can enjoy better work- life balance on a team that values collaboration and continuous learning while providing better health outcomes. **Collaboration Opportunities:** + Routinely interacts with leadership and management staff, other Physicians, and staff whenever a physician`s input is needed or required. As well as, aids and acts as a resource to Initial Clinical Reviewers. **What You Will Be Doing:** + Serve as the specialty match reviewer in Cardiology cases, that do not initially meet the applicable medical necessity guidelines, as well as other requests when providers, clients, or state laws require specialty reviews to be completed by the subject matter expert. + Provides clinical rationale for standard and expedited appeals. + Discusses determinations (peer to peer phone calls) with requesting physicians or ordering providers, when available, within the regulatory timeframe of the request. + Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD review process to reflect appropriate utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance (NCQA) guidelines. + Ensures documentation of all communications with medical office staff and/or MD provider is recorded in a timely and accurate manner. + Participates in on-going training per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. + On a requested basis, may function as Medical Director for selecting health plans or regions, assuming overall accountability for utilization management while working in conjunction with the Senior Medical Director. **Qualifications - Required and Preferred:** + MD/DO/MBBS Degree + Current, unrestricted clinical license in medicine or required specialty + Obtaining and maintaining medical licenses in the state you reside, as well as, other state licensure required per business needs + Active Board Certification in Cardiology, Vascular Surgery or Adult Congenital Heart Disease + Strong clinical, management, communication, and organizational skills + Energetic and curious with a passion for quality and value in health care + Computer Proficiency + Minimum of five (5) years' experience in the practice of Cardiology is preferred + Not under current exclusion or sanction by any state or federal health care program, including Medicare or Medicaid, and is not identified as an "excluded person" by the Office of Inspector General of the Department of Health and Human Services or the General Service Administration (GSA), or reprimanded or sanctioned by Medicare. + No history of a major disciplinary or legal action by a state medical board To ensure a secure hiring process we have implemented several identity verification steps, including submission of a government issued photo ID. We conduct identity verification during interviews, and final interviews may require onsite attendance. All candidates must complete a comprehensive background check, in-person I-9 verification, and may be subject to drug screening prior to employment. The use of artificial intelligence tools during interviews is prohibited and monitored. Misrepresentation will result in immediate disqualification from consideration. **Technical Requirements:** We require that all employees have the following technical capability at their home: High speed internet over 10 Mbps and, specifically for all call center employees, the ability to plug in directly to the home internet router. These at-home technical requirements are subject to change with any scheduled re-opening of our office locations. **Evolent is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, or disability status.** **If you need reasonable accommodation to access the information provided on this website, please contact** ************************** **for further assistance.** The expected base salary/wage range for this position is $120-$135/hr. This position is also eligible for a bonus component that would be dependent on pre-defined performance factors. As part of our total compensation package, Evolent is proud to offer comprehensive benefits (including health insurance benefits) to qualifying employees. All compensation determinations are based on the skills and experience required for the position and commensurate with experience of selected individuals, which may vary above and below the stated amounts. Don't see the dream job you are looking for? Drop off your contact information and resume and we will reach out to you if we find the perfect fit!

The Medical Director, Rheumatology and/or Dermatology Medical Strategy is a critical role responsible for shaping the strategic processes and planning for assets in early development (e.g., pre-Phase 3) within the Nephrology and Immunology portfolio. This position manages the unique challenge of establishing an emerging portfolio, incorporating newly acquired assets, which requires significant scientific and strategic agility and a strong ability to balance competing priorities. This position reports directly to the Senior Director, Immunology Lead, who in turn reports to the Executive Director, Nephrology & Immunology Lead. **** **Key Responsibilities Include:** **Medical Strategy & Narrative** + Provide key medical input into the initial development of the Target Reimbursable Product Profile as well as early development plans ensuring scientific consistency and alignment across R&D, Clinical, Global Medical Affairs, and Early Commercialization functions + Provide high-quality scientific/clinical input and review of early asset plans, ensuring content aligns with the overarching Medical Narrative + Serve as a primary scientific resource, providing guidance on the disease state and mechanism of action for the early Nephrology and Immunology portfolio helping to translate science into value for patients and stakeholders + Lead the Strategy and Tactical Planning Process, identifying critical data needs for the emerging portfolio **Evidence Generation Process** + Oversee the Medical Evidence Generation Process, translating strategic data gaps into clear research priorities and providing expert input into the design and feasibility of clinical trials and data generation initiatives + Support the planning and execution of Medical Affairs evidence generation activities relevant to early assets **External Stakeholder Engagement** + Identify and engage Medical experts to support collection, curation and communication of clinical Medical and methodological insights to inform understanding of unmet medical needs, emerging standard of care and development opportunities + Develop Key Intelligence Topics & Questions (KITs/KIQs) for relevant assets, serving as the blueprint for insight collection from Medical Experts + Lead the strategic planning, content development, and successful facilitation of consulting activities including Advisory Boards, ensuring objectives align with data gap analyses and asset/portfolio strategy + Lead scientific exchange with Medical Experts to gather insights and validate development hypotheses + Support the development of scientific publications, abstracts, and presentations related to early assets **Cross-functional Integration & Planning** + Collaborate within the Nephrology & Immunology Medical Business Unit with the Nephrology & Immunology Medical Communications and Field Medical Affairs sub-teams + Partner with and serve as a scientific and clinical resource for cross-functional colleagues including Clinical Development, Global Integrated Evidence & Innovation, Regulatory and Global Marketing and Market Access + Support indication prioritization and portfolio planning for early assets + Consider technology and AI to support workflow improvement **Qualifications** **Education and Experience:** + Advanced scientific degree is required (PharmD, MD, PhD, or equivalent) with expertise in **Rheumatology and/or Dermatology** + Preference for previous experience in Clinical Development, Research, or early-stage Medical Affairs + Expertise in Rheumatology or Dermatology is strongly preferred + Experience supporting BD evaluations for potential acquisitions + Experience contributing to the integration and strategic planning for newly acquired or in-licensed assets + Proven experience managing Evidence Generation processes and executing scientific Advisory Boards **Skills and Competencies:** + Motivated and solution-oriented with the ability to work collaboratively across the organization, particularly with R&D and Clinical teams + Strategic agility required to build and adapt scientific strategy for an emerging portfolio + Excellent communication and interpersonal skills, including experience presenting complex development strategies to large internal groups and engaging a limited number of highly specialized external experts + Full understanding of rules and regulations in pharma, with the ability to apply knowledge of guidelines and regulations to early-stage Medical Affairs activities + Ability to work in a fast-paced, dynamic environment, with a proactive and problem-solving mindset + Strong understanding of drug development processes, especially early-stage development + \#LI-PG1 **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 $209,599.00 - Maximum $313,375.00, 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.

Responsibilities will include oversight of hospital operations, financial management, and regulatory compliance. Leads the facility management staff and consultants in developing and working from a business plan that focuses on all aspects of facility operations, including setting priorities and job assignments. Monitors each department's activities, communicates policies, evaluates performance, provides feedback, and assists, observes, coaches and disciplines as needed. Oversees regular rounds to monitor delivery of nursing care, operation of support departments, cleanliness and appearance of the facility; moral of the staff; and ensures resident needs are being addressed. Develops positive relationships on behalf of the Company with government regulators, residents, families, area health care, physicians, and the community at large. Acts as a resource of information to the community related to health care issues. Exhibits positive customer service both to internal and external customers through the ongoing support and implementation of the Company's Health and Rehabilitation Services customer service initiatives and business objectives. Utilizes survey information to address areas of importance as defined by our customers. Ensures consultants and other support resources are appropriately utilized and a high level of interdepartmental teamwork is maintained. Maintain a working knowledge of and ensure compliance with all governmental regulations. Monitor Human Resources practices to ensure compliance with employment laws and company policies, and to ensure practices that maintain high morale and staff retention to include effective communication, prompt problem resolution, proactive supervisory practices, and maintaining a proactive work environment. Manage turnover and ensure current and future staffing through development of recruiting sources, and through appropriate selection, orientation, training, staff education and development. Develop and implement a marketing strategy for the facility that reflects service opportunities, competition, potential market area changes, and which maximizes census, payor mix, and ancillary revenues. Lead and monitor key staff and facility staff to play an active role in carrying out the marketing plan. Take initiative in evaluation, development and implementation of new business opportunities that meets the needs of the community and benefits the facility/Company. Comply with, support and enforce Company policies involving all safety and infection control procedures. Promote and understanding of and compliance with all rules regarding resident's rights; promote positive relationships with residents, visitors and regulators. Supervise, conduct and participate in department and facility education activities and staff meetings. Utilize the quality improvement process in all areas of facility operation. Qualifications Degree and/or experience in a Physical Therapy/Hospital/Nursing Home/Assisted Living Setting. Master's Degree preferred Five or more years of recent hospital therapy management and/or supervisory experience. Must have record of demonstrating leadership competencies and management style that exemplify clients values. Substantial knowledge of applicable State, Federal and local codes, regulations, laws and regulatory compliance process. Knowledge of current and emerging industry trends affecting health care and rehabilitation practice. Demonstrated excellent written and verbal communication skills, and leadership competencies. Must possess basic computer knowledge Keywords: Rehabilitation, Nursing, Speech Language Pathologist, Occupational Therapist, Physical Therapist, Case Management, Social Services. Additional Information All your information will be kept confidential according to EEO guidelines.

The Medical Director, Rare Disease is a critical role responsible for shaping the strategic processes and planning for assets in across phases of development within the Rare Disease portfolio. This position manages the unique challenge of establishing an emerging portfolio, incorporating newly acquired assets, which requires significant scientific and strategic agility and a strong ability to balance competing priorities. This position reports directly to the Rare Disease Medical Business Unit (BU) Lead. **** **Key Responsibilities Include:** **Medical Strategy & Narrative** + Provide key medical input into the initial development of the Target Reimbursable Product Profile as well as early development plans ensuring scientific consistency and alignment across functions (e.g., R&D, Clinical, Global Medical Affairs) + Provide high-quality scientific/clinical input and review of early asset plans, ensuring content aligns with the overarching Medical Narrative + Lead and nurture strategic partnerships with stakeholders by ensuring clear, consistent communication and aligning initiatives with partner priorities to strengthen collaboration and drive shared success in the rare disease space + Serve as a primary scientific resource, providing guidance on the disease state and mechanism of action for the Rare Disease portfolio helping to translate science into value for patients and stakeholders + Lead the Strategy and Tactical Planning Process, identifying critical data needs for the emerging portfolio **Evidence Generation Process** + Oversee the Medical Evidence Generation Process in partnership with GIE&I, translating strategic data gaps into clear research priorities and providing expert input into the design and feasibility of innovative clinical trials and data generation initiatives + Support the planning and execution of Medical Affairs evidence generation activities relevant to the Rare Disease portfolio **External Stakeholder Engagement** + Identify and engage a wide variety of stakeholders, including KOL experts and patient advocacy groups to support collection, curation and communication of clinical Medical and methodological insights to inform understanding of unmet medical needs, emerging standard of care and development opportunities + Develop Key Intelligence Topics & Questions (KITs/KIQs) for relevant assets, serving as the blueprint for insight collection from Key Opinion Leaders + Lead the strategic planning, content development, and successful facilitation of consulting activities including Advisory Boards, ensuring objectives align with data gap analyses and asset/portfolio strategy + Lead scientific exchange with key opinion leaders (KOLs) to gather insights and validate development hypotheses + Support the development of scientific publications, abstracts, and presentations related to the Rare Disease portfolio **Cross-functional Integration & Planning** + Collaborate within the Rare Disease Medical Business Unit with the Rare Disease Medical Communications and Field Medical Affairs sub-teams + Partner with and serve as a scientific and clinical resource for cross-functional colleagues including Clinical Development, Global Integrated Evidence & Innovation, Regulatory and Global Marketing and Market Access + Support indication prioritization and portfolio planning for early assets + Manage assigned Rare Disease medical program budgets in partnership with the Rare Disease Medical BU lead, ensuring accurate forecasting, responsible resource utilization, and compliance with internal policies and external regulations + Consider technology and AI to support workflow improvement **Qualifications** **Education and Experience:** + Advanced scientific degree is required (PharmD, MD, PhD, or equivalent) with extensive expertise in Rare Disease + Minimum of 5+ years of relevant experience in the pharmaceutical industry, with strong preference for experience in Clinical Development, Research, or Medical Affairs + Experience supporting BD evaluations for potential acquisitions + Experience contributing to the integration and strategic planning for newly acquired or in-licensed assets + Proven experience managing Evidence Generation processes and executing scientific Advisory Boards **Skills and Competencies:** + Strong leadership presence and ability to present to executive leadership team + Skilled in cultivating strong relationships with global medical partners through proactive communication and strategic prioritization + Motivated and solution-oriented with the ability to work collaboratively across the organization, particularly with R&D and Clinical teams + Strategic agility required to build and adapt scientific strategy for an emerging portfolio + Excellent communication and interpersonal skills, including experience presenting complex development strategies to large internal groups and engaging a limited number of highly specialized external experts + Full understanding of rules and regulations in pharma, with the ability to apply knowledge of guidelines and regulations to early-stage Medical Affairs activities + Ability to work in a fast-paced, dynamic environment, with a proactive and problem-solving mindset + Strong understanding of drug development processes, especially early-stage development + Openness to travel up to ~25% for 3 - 6 conferences in US and globally **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 $209,599.00 - Maximum $313,375.00, 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.

**Your Future Evolves Here** Evolent partners with health plans and providers to achieve better outcomes for people with most complex and costly health conditions. Working across specialties and primary care, we seek to connect the pieces of fragmented health care system and ensure people get the same level of care and compassion we would want for our loved ones. Evolent employees enjoy work/life balance, the flexibility to suit their work to their lives, and autonomy they need to get things done. We believe that people do their best work when they're supported to live their best lives, and when they feel welcome to bring their whole selves to work. That's one reason why diversity and inclusion are core to our business. Join Evolent for the mission. Stay for the culture. **What You'll Be Doing:** Job Description As a FMD, Radiology you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in patients lives, in a non-clinical environment. You can enjoy better work- life balance on a team that values collaboration and continuous learning while providing better health outcomes. **Collaboration Opportunities:** + Routinely interacts with leadership and management staff, other Physicians, and staff whenever a physician`s input is needed or required. **What You Will Be Doing:** + Serve as the Physician match reviewer in Imaging cases, that do not initially meet the applicable medical necessity guidelines, as well as other imaging requests when providers, clients, or state laws require specialty reviews to be completed by the subject matter expert. + Discusses determinations (peer to peer phone calls) with requesting physicians or ordering providers, when available, within the regulatory timeframe of the request and provides clinical rationale for standard and expedited appeals. + Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD review process to reflect appropriate utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance (NCQA) guidelines. + Aids and acts as a resource to Initial Clinical Reviewers. + Ensures documentation of all communications with medical office staff and/or MD provider is recorded in a timely and accurate manner. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. + Participates in on-going training per inter-rater reliability process. **Qualifications:** + MD/DO/MBBS + Minimum of five (5) years' experience in the practice of Medicine, post residency and Active Clinical practice within the last 2 years is preferred + Current, unrestricted clinical license in medicine or required specialty- + Obtaining and maintaining medical licenses in the state you reside, as well as, any license required per business needs + Active Board Certification by an accredited organization + Strong clinical, management, communication, and organizational skills + Energetic and curious with a passion for quality and value in health care + Computer Proficiency + Not under current exclusion or sanction by any state or federal health care program, including Medicare or Medicaid, and is not identified as an "excluded person" by the Office of Inspector General of the Department of Health and Human Services or the General Service Administration (GSA), or reprimanded or sanctioned by Medicare. + No history of a major disciplinary or legal action by a state medical board To ensure a secure hiring process we have implemented several identity verification steps, including submission of a government issued photo ID. We conduct identity verification during interviews, and final interviews may require onsite attendance. All candidates must complete a comprehensive background check, in-person I-9 verification, and may be subject to drug screening prior to employment. The use of artificial intelligence tools during interviews is prohibited and monitored. Misrepresentation will result in immediate disqualification from consideration. **Technical Requirements:** We require that all employees have the following technical capability at their home: High speed internet over 10 Mbps and, specifically for all call center employees, the ability to plug in directly to the home internet router. These at-home technical requirements are subject to change with any scheduled re-opening of our office locations. **Evolent is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, or disability status.** **If you need reasonable accommodation to access the information provided on this website, please contact** ************************** **for further assistance.** The expected base salary/wage range for this position is $94-99/hr. This position is also eligible for a bonus component that would be dependent on pre-defined performance factors. As part of our total compensation package, Evolent is proud to offer comprehensive benefits (including health insurance benefits) to qualifying employees. All compensation determinations are based on the skills and experience required for the position and commensurate with experience of selected individuals, which may vary above and below the stated amounts. Don't see the dream job you are looking for? Drop off your contact information and resume and we will reach out to you if we find the perfect fit!