Medical Director
Medical director job in Raleigh, NC
Med First is committed to expanding access to high-quality primary care in underserved communities. We're looking for a Medical Director who can lead with both clinical excellence and operational insight- advancing value-based care and sustainable growth across 25+ clinics.
How You'll Make an Impact:
Lead clinical strategy, quality, and patient safety across diverse, community-based settings
Advance value-based care, care management, and use of innovative AI models
Partner with operations/finance on access, growth, and performance (MLR, quality, experience)
Develop clinical leaders, recruit/retain talent, and foster a culture of compassion + accountability
Provide direct patient care in one of our primary care sites
Who you are:
Board-certified (FM/IM) with 5+ years of clinical leadership, success in value-based and multi-site environments, and a mission-driven, collaborative mindset.
Location: Hybrid: 2 days work in clinic at our Roxboro NC clinic and 2 days administrative working remotely.
DIRECTOR OF NURSING (DON) - LOUISBURG HEALTH & REHAB CENTER
Medical director job in Louisburg, NC
Liberty Cares With Compassion
***$20,000 Sign on Bonus***
At Liberty Healthcare and Rehabilitation Services, we promote a challenging but rewarding opportunity in a caring environment.
We are currently seeking an experienced:
DIRECTOR OF NURSING (DON)
Job Description:
Ensures the provision of quality, compliant patient care through the supervision and coordination of all nursing services, while monitoring adherence to regulatory policies and procedures, and representing the facility in a professional manner to patients, families, staff, physicians, and the general public.
Participates in staffing processes.
Recommends and conducts in-services.
Handles performance management issues, as needed.
Job Requirements:
Registered nurse in North Carolina.
Preferred minimum of three years of long-term care experience in a leadership role.
Strong communication and organizational skills, including computer proficiency.
Visit ********************************* for more information.
Background checks/Drug free workplace.
EOE.
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Interim Director of Nursing
Medical director job in Roxboro, NC
ABOUT THE JOB
We are seeking a motivated Director of Nursing - DON for a 13-week assignment in NC.
QUALIFICATIONS
Required Experience: Recent Leadership experience
License: Active Registered Nurse Licensure in NC
Education: Bachelor's Degree
ABOUT OUR PREMIER DIVISION
LeaderStat's Premier Division is dedicated to collaborating closely with you to pair you up on assignments that fit your needs. We have Consultant Specialists who ensure your housing and travel coordination goes off seamlessly. We know that keeping you happy also keeps our clients happy, so we strive to provide you with fulfilling assignments.
LEADERSTAT INTERIM BENEFITS
Competitive Pay
Paid Time Off
Holiday Pay - (7 days per year)
W2 Employee Status
Weekly Pay & Direct Deposit
401(k) Retirement Plan
Medical Insurance
Dental Insurance
Vision Insurance
Educational Programs
Travel Reimbursement
Licensure Reimbursement
Referral Bonuses
Dedicated Support Team
Equal Employment Opportunity:
LeaderStat, Ltd. prohibits discrimination with respect to the hiring or promotion of individuals, conditions of employment, disciplinary and discharge practices or any other aspect of employment on the basis of sex, race, color, age, national origin, religion, disability, marital status, sexual orientation, gender identity, pregnancy or veteran status
Assistant Director of Nursing
Medical director job in Asheboro, NC
Assistant Director, Inpatient Services (Hospice) - Asheboro, North Carolina
A respected nonprofit hospice organization in High Point is seeking an Assistant Director of Inpatient Services to support clinical operations within their inpatient unit. This is a full-time, on-site leadership role (Monday-Friday, 8-5) focused on high-quality, compassionate end-of-life care.
Key Responsibilities:
• Provide daily leadership and supervision for inpatient nursing and support staff
• Support referrals, admissions, and overall coordination of care
• Mentor and serve as a clinical resource for RNs, CNAs, and interdisciplinary team members
• Ensure compliance with care standards, safety, and regulatory guidelines
• Participate in hiring, onboarding, evaluations, and staff development
• Facilitate interdisciplinary team meetings and ongoing quality review
• Serve as acting leader in the Director's absence
Requirements:
• RN licensed in NC; Associate's required, BSN preferred
• 3+ years clinical RN experience (hospice, palliative, oncology, or critical care ideal)
• 2+ years leadership experience
• Strong communication, organization, and team-building skills
• Valid driver's license and required insurance
This role is ideal for a collaborative, servant-minded clinical leader who values trust, teamwork, and mission-driven care.
Medical Director - Medical Policy
Medical director job in Durham, NC
Medical Director- Medical Policy Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. Alternate locations may be considered.
The Medical Director- Medical Policy is responsible for the administration of medical services for company health plans and helps ensure clinical integrity of broad and significant clinical programs, including the overall medical policies of the enterprise.
How you will make an impact:
* Responsible for active engagement in and development of medical policy across Elevance Health.
* Additional responsibilities may include oversight of preventive health service recommendations as well as credentialing policies.
* This position will also be active in engagement with external specialty societies and other external facing medical professional activities for the company.
* Interprets existing policies and develops new policies based on changes in the healthcare or medical arena.
* Leads, develops, directs and implements clinical and non-clinical activities that impact health care quality cost and outcomes.
* Supports the Medical Policy staff ensuring timely and consistent responses to members and providers.
* Supports coordination with external entities that develop clinical utilization management guidelines used by Company Plans (e.g., MCG Care guidelines, Carelon Medical Benefits Management guidelines and CarelonRx)
* Identifies and develops opportunities for innovation to increase effectiveness and quality.
* Serves as a resource and consultant to other areas of the company.
* May chair or serve on company committees including chair of the National Credentialing Committee.
Minimum Requirements:
* Requires MD or DO and Board certification approved by one of the following certifying boards is required, where applicable to duties being performed, American Board of Medical Specialties (ABMS) or American Osteopathic Association (AOA).
* Must possess an active unrestricted medical license to practice medicine or a health profession.
* Unless expressly allowed by state or federal law, or regulation, must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US military base, vessel or any embassy located in or outside of the US.
* Minimum of 10 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
* For Health Solutions and Carelon organizations (including behavioral health) only, minimum of 5 years of experience providing health care is required. Additional experience may be required by State contracts or regulations if the Medical Director is filing a role required by a State agency.
Preferred Qualifications:
* Extensive managed care or Medicare knowledge.
* MPH or MS in Epidemiology preferred, or equivalent experience and knowledge in evidence-based medicine and clinical epidemiology.
* Proficiency in writing preferred.
For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $262,152 to $393,228.
Locations: Illinois
In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.
* The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law.
Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Who We Are
Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
How We Work
At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ******************************************** for assistance.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
Auto-ApplyPCO Medical Director- UM - Full Time
Medical director job in Raleigh, NC
**Become a part of our caring community and help us put health first** The Medical Director, Primary Care relies on medical background and reviews health claims. The Medical Director, Primary Care work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.
The Medical Director relies on medical background and reviews health claims. The Medical Director work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.
The Medical Director actively uses their medical background, experience, and judgement to make determinations whether requested services, requested level of care, and/or requested site of service should be authorized. All work occurs with a context of regulatory compliance, and work is assisted by diverse resources which may include national clinical guidelines, CMS policies and determinations, clinical reference materials, internal teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and Medicare Advantage requirements and will understand how to operationalize this knowledge in their daily work.
The Medical Director's work includes computer-based review of moderately complex to complex clinical scenarios, review of all submitted clinical records, prioritization of daily work, communication of decisions to internal associates, participation in care management and possible participation in care facilitation with hospitals. The clinical scenarios predominantly arise from inpatient or post-acute care environments. There are discussions with external physicians by phone to gather additional clinical information or discuss determinations regularly, and in some instances, these may require conflict resolution skills. An aspect of the role includes an overview of coding practices and clinical documentation, grievance and appeals processes, and outpatient services and equipment, within their scope.
The Medical Director may speak with contracted external physicians, physician groups, facilities, or community groups to support regional market care facilitation and priorities, which may include an understanding of Humana processes, as well as a focus on collaborative business relationships, value-based care, population health, or disease or care management.
**Use your skills to make an impact**
**Responsibilities**
The Medical Director provides medical interpretation and determinations whether services provided by other healthcare professionals are in agreement with national guidelines, CMS requirements, Humana policies, clinical standards, and (in some cases) contracts. The ideal candidate supports and collaborates with other team members, other departments, Humana colleagues and the Regional VP Health Services. After completion of mentored training, daily work is performed with minimal direction. Enjoys working in a structured environment with expectations for consistency in thinking and authorship. Exercises independence in meeting departmental expectations and meets compliance timelines.
**Required Qualifications**
+ MD or DO degree.
+ 5+ years of direct clinical patient care experience post residency or fellowship, which preferably includes some experience in an inpatient environment and/or related to care of a Medicare type population (disabled or >65 years of age).
+ Current and ongoing Board Certification in an approved ABMS Medical Specialty as well as ABQAURP, or other boarddemonstratingadvanced training in transitions of care, quality assurance,utilizationmanagementand care coordination.
+ A current and unrestricted license in at least onejurisdictionand willing to obtainadditionallicense, ifrequired.
+ No currentsanctionfrom Federal or State Governmental organizations, and able to pass credentialing requirements.
+ Excellent organizational,verbaland written communication skills.
+ Evidence of analytic and interpretation skills, with prior experienceparticipatingin teams focusing on transitions of care, quality management,utilizationmanagement, case management, discharge planning and/or home health or post-acute services such as inpatient rehabilitation.
**Preferred Qualifications**
+ Knowledge of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other medical management organizations, hospitals/ Integrated Delivery Systems, health insurance, other healthcare providers, clinical group practice management.
+ Utilizationmanagement experience in a medical management review organization, such as Medicare Advantage,managed Medicaid, or Commercial health insurance.
+ Experience with national guidelines such as MCG or InterQual.
+ Internal Medicine, Family Practice, Geriatrics, Hospitalist, Emergency Medicine clinical specialists
+ Advanceddegreesuch as an MBA, MHA, MPH
+ Exposure to value-based care, Public Health, Population Health, analytics, and use of business metrics.
+ Experience working with Casemanagersor Caremanagerson complex case management, including familiarity with social determinants of health.
+ The curiosity to learn, the flexibility toadaptand the courage to innovate.
**Additional Information**
Will report to the Director of Physician Strategy at Utilization Management. The Medical Director conducts Utilization review of the care received by members in an assigned region, market, member population, or condition type. May also engage in grievance and appeals reviews. May participate on project teams or organizational committees.
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.
$223,800 - $313,100 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: 12-31-2025
**About us**
About Conviva Senior Primary Care: Conviva Senior Primary Care provides proactive, preventive care to seniors, including wellness visits, physical exams, chronic condition management, screenings, minor injury treatment and more. As part of CenterWell Senior Primary Care, Conviva's innovative, value-based approach means each patient gets the best care, when needed most, and for the lowest cost. We go beyond physical health - addressing the social, emotional, behavioral and financial needs that can impact our patients' well-being.
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 *************************************************************
Medical Director-Dermatology Appeals
Medical director job in Durham, NC
**Location:** This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be considered. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.
The **Medical Director-Dermatology Appeals** is responsible for the review of appeals for physical health medical services, to ensure the appropriate and most cost-effective medical care is received. May be responsible for developing and implementing programs to improve quality, cost, and outcomes. May provide clinical consultation and serve as clinical/strategic advisor to enhance clinical operations. May identify cost of care opportunities. May serve as a resource to staff including Medical Director Associates. May be responsible for an entire clinical program.
**How you will make an impact:**
+ Complete appeal reviews in your specialty daily to ensure timely and consistent responses to members and providers.
+ Provide guidance for clinical operational aspects of a program.
+ May conduct peer-to-peer clinical reviews with attending physicians or other providers to discuss review determinations
+ Serve as a resource and consultant to other areas of the company.
+ May be required to represent the company to external entities and/or serve on internal and/or external committees.
+ May chair company committees.
+ Interpret medical policies and clinical guidelines.
+ May lead, develop, direct, and implement clinical and non-clinical activities that impact health care quality cost and outcomes.
+ Identify and develop opportunities for innovation to increase effectiveness and quality.
+ Work independently with oversight from immediate manager.
+ May be responsible for an entire clinical program and/or independently perform clinical reviews.
**Minimum Qualifications**
+ Requires MD or DO and Board certification approved by one of the following certifying boards is required, where applicable to duties being performed: American Board of Medical Specialties (ABMS) or American Osteopathic Association (AOA).
+ Board certification in Dermatology.
+ Must possess an active unrestricted medical license to practice medicine or a health profession. Unless expressly allowed by state or federal law, or regulation, must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US military base, vessel or any embassy located in or outside of the US.
+ Minimum of 10 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
+ For Health Solutions and Carelon organizations (including behavioral health) only, minimum of 5 years of experience providing health care is required.
+ Additional experience may be required by State contracts or regulations if the Medical Director is filling a role required by a State agency.
+ For URAC accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written, and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills. If this job is assigned to any Government Business Division entity, the applicant and incumbent fall under a sensitive position work designation and may be subject to additional requirements beyond those associates outside Government Business Divisions. Requirements include but are not limited to more stringent and frequent background checks and/or government clearances, segregation of duties, principles, role specific training, monitoring of daily job functions, and sensitive data handling instructions. Associates in these jobs must follow the specific policies, procedures, guidelines, etc. as stated by the Government Business Division in which they are employed.
Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Who We Are
Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
How We Work
At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ******************************************** for assistance.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
Medical Director
Medical director job in Raleigh, NC
Who is Nest Health?
As the first value-based care provider built for families, Nest is on a mission to make comprehensive medical, behavioral, and social care radically accessible to America's highest risk families. Nest's first-of-its-kind family-based, in-home, and virtual care model includes primary adult and pediatric care, mental health and nutrition support, vaccinations and labs, same-and-next-day acute visits, chronic condition and transitions of care management, social services and navigation, and more. Nest's innovative model has resulted in partnerships, unlocking care for thousands of families across our markets. Nest's early success has led to national traction across states and payers, laying the groundwork for future expansion to families across the United States.
What does it mean to be a part of a startup?
Working at a healthcare startup can be a unique experience with a fast-paced, ever-changing environment that can involve varied workloads, quick changes, and high expectations. Taking a position at a Healthcare startup allows for the opportunity to be high impact in disrupting the US healthcare system. You will have the chance to be creative, solution oriented, and have your voice heard! You will need to be flexible, accountable, and self-sufficient, and you might take on multiple roles. Here are some things you can expect:
Role Breadth-
Your role may be less defined than in other settings, with the need to wear multiple hats & juggle various responsibilities
Learning opportunities-
you will have the opportunity, at times, to function outside of your standard position and learn about new roles & areas
Fast Paced-
Startups often must move faster than traditional large companies. This means you may be asked to cope with or advise on quick changes regarding systems or processes
Autonomy-
You will need to be highly autonomous, as there is less structure and learning and development than at large orgs. This requires you to be able to learn asynchronously, as well as raise your hand when help is needed, or gaps are identified
Collaboration-
With so many opportunities to build processes and improve how we deliver care to our patients, we rely heavily on one-another to communicate changes effectively to ensure seamless support across functions. This often requires this individual to give and receive feedback frequently and communicate challenges or opportunities effectively.
What is the purpose of this role?
The Medical Director provides cross-market clinical leadership and oversight, ensuring excellence in care delivery across Nest Health's growing footprint. Reporting to the Chief Clinical Officer and serving as a key member of the clinical leadership team, the Medical Director partners with pod leaders and contracted physicians to drive performance in quality, patient experience, outcomes, and value-based care.
This role blends system-level leadership with hands-on clinical engagement through ride alongs, chart reviews, and periodic patient care coverage (primarily virtual). The Medical Director also serves as a clinical ambassador in external conversations- representing Nest's model and results in payer discussions and supporting strategic partnerships.
The ideal candidate is both innovative and practical, skilled at providing and coaching full-spectrum family medicine in a value-based model. This role is essential in building scalable clinical operations that advance Nest's mission of radically accessible family care.
What will you do?
Provide leadership and oversight to pod leaders across multiple Nest markets, ensuring alignment with clinical standards, protocols, and organizational goals
Oversee contracted physicians responsible for collaborative practice agreements or virtual care, ensuring appropriate supervision and compliance with state regulatory requirements
Foster collaboration and drive clinical performance, quality improvement and access, building team capacity to deliver best in class longitudinal primary care and care coordination for Nest families
Help define and monitor clinical performance metrics related to value-based care, including utilization, quality, and patient satisfaction
Participate in interdisciplinary care coordination and case review processes across markets
Collaborate with external partners, including payers and health systems, to promote the Nest model and support clinical integration
Provide limited virtual direct patient care on an as-needed basis to support market needs and maintain connection to the care model
Intermittent travel to Nest markets to support clinical oversight and team engagement
Remain current in the knowledge of pediatrics and adult primary and acute care, utilization management, quality management, managed care principals and new clinical developments and technologies
What do you bring to the Nest?
Current Board-Certification in Internal Medicine and Pediatrics OR Family Medicine
Active Medical License or eligible for application within the US
Active DEA Controlled Substance Registration or eligible for application
Minimum of three years (5+ years preferred) clinical experience providing clinical services to children and adults with both chronic medical and behavioral health conditions; plus 2+ years in a leadership role (residency experience can count toward these requirements)
Mission-driven, goal-oriented and passionate about underserved populations, community health, and the emerging Nest Health Care model
Available to work full time and participate in a rotating call schedule
Experience working as a member of an interdisciplinary care team preferred
Experience in a population health- and value-based model is strongly preferred but not required
Experience precepting and mentoring students, residents, and advanced practitioners is a plus but not required
Please note, this position will involve educating and encouraging all vaccinations including COVID-19
Skills and Competencies
Passion for improving care for underserved populations, particularly those covered by Medicaid
Excellent stakeholder management and relationship- building skills
Superior written and verbal communication with the ability to tailor messages to investors, payers, and clinical team members
Exceptional time management and attention to detail
Strong problem-solving and analytical capabilities
What is required (travel & physical requirements)?
In-person visits will be completed in the patient's home. The physician will be expected to observe in-person visits to assess clinical capabilities of advanced practice providers
This role will be primarily remote, however travel to markets to provide in-person oversight and leadership will be required
Additional travel to HQ/other markets may be required to support team building, training, or organizational meetings
Must be able to lift up to 25 pounds at times
Nest understands that job requirements sometimes exclude people who identify with historically marginalized groups from applying to jobs for which they are qualified. Even if you don't meet 100% of the requirements listed, or if you achieved these requirements through unconventional channels, we encourage you to apply.
What does Nest bring to the table?
We are reimagining what a supportive workplace looks like, from the inside out. To ensure every team member feels valued, we provide competitive compensation packages that reflect your skills and contributions. On top of this, we offer a comprehensive suite of benefits such as employer-sponsored health, dental, and life options, and unlimited PTO, we offer an all-of-you, inclusive approach to benefits:
Family- centric health support with access to Lyric's comprehensive services for urgent care, behavioral health, psychology, and psychiatry for you and your entire family, including virtual veterinary care for your pets
Company supported Parental Leave for both primary/non-primary care givers with options for a tiered return to work, and eligibility to receive additional hours PTO for Prenatal Care and Backup Childcare
Receive reimbursement for work- related vehicle expenses, including commuting and travel costs, for staff who drive as part of their job responsibilities
Opportunity to receive up to $3,000/year Tuition Reimbursement to support your educational and professional development by covering a portion of costs relating to fees, course materials, or other related expenses
Receive employer sponsored short-term and long-term disability benefits to provide financial support in the event of illness or injury that prevents you from working
Enrollment in 401 (k) Retirement Plan through Human Interest to help save for your future with flexible contribution options
Why choose Nest Health?
Nest and its leaders have won multiple awards including Rock Health's Next-Gen Pediatric innovations, New York Times Top Five Who Spread Hope, New Orleans City Business Power 50, and CB Insights Digital 150. Additionally, Nest has become a prominent thought and brand leader garnering national attention from outlets such as 60 Minutes, Business Insider, NYTimes, Fierce Healthcare, Axios , and others. More recently, they were recognized on Inc.'s Female Founder 500 List for 2025.
Founded in 2022 by Former Secretary of Health of Louisiana and practicing OB-GYN, Dr. Rebekah Gee, and Rebecca Kavoussi, former President at Landmark Health, Nest has raised a historical Seed round of over $20M from top healthcare and industry investors including 8VC, Blue Venture Fund, SpringTide Health, Alumni Ventures, Gaingels, MVP, Health 2047, Ochsner Louisiana Investment Fund, Tulane Ventures, and others.
Learn more about us at ****************************
To learn more about the Nest care model, watch this video, by the award- winning HBO Katrina Babies filmmaker Edward Buckles, JR.
Nest Health celebrates the diversity of our patient population and seeks diversity on our team.
We are an equal opportunity employer, indiscriminate of race, religion, ethnicity, national origin, citizenship, gender, gender identity, sexual orientation, age, veteran status, disability, genetic information, or any other protected characteristics.
Auto-ApplyPsychiatrist - Medical Director -Part-time
Medical director job in Raleigh, NC
Job DescriptionMedical Director - Psychiatrist Durham, North Carolina We have an opportunity available for a board certified/eligible psychiatrist to join our team as Medical Director in Durham, North Carolina. This is a contracted position for 1-day per week with oversight and clinical supervision of advanced practice providers.
Responsibilities include being fully engaged with the clinical team and active in the development of the clinical oversight of our behavioral health and substance abuse programs.
You will also directly supervise complex cases and you will be responsible for reviewing the clinical provision of services for appropriate referral patterns within and outside of the agency.
You will also be responsible for the implementation of evidence based and best practice models of care, review of labs and toxicology screens and oversight of COVID protocols and implementation.
THE QUALIFICATIONS -Must be a North Carolina licensed MD or DO-Board certification/board eligibility in psychiatry is required-At least one year of psychiatrist experience is required
CLIA Laboratory and Medical Director (relocation offered to Raleigh, NC area)
Medical director job in Morrisville, NC
Job Description
SAGA Diagnostics is a personalized cancer diagnostics and disease monitoring company focused on molecular genetic analysis of circulating tumor DNA (ct DNA). The company's mission is to improve precision cancer medicine, provide more accurate treatment monitoring, and improve patient survival using minimally invasive liquid biopsy cancer testing services. SAGA's proprietary tests can help patients, oncologists, and drug developers detect actionable mutations, stratify patient groups, and monitor treatment response, residual disease, and disease recurrence at unprecedented sensitivity and scale. SAGA Diagnostics recently established a US operation in Research Triangle Park (RTP) and is excited to invite you to join our dedicated team.
The CLIA Laboratory and Medical Director is responsible for ensuring the delivery of quality clinical laboratory services. This position will serve as the CLIA Laboratory Director and be listed on the CLIA license. Specific responsibilities will include histology slide assessment, tissue selection, molecular assay interpretation and sign-out, assay development and validation, participation in laboratory operations, and improving digital pathology capabilities.
Essential Duties and Responsibilities:
Responsibilities in operating the histopathology laboratory under CLIA, CAP, NYS, and all other applicable regulations.
Responsible for slide review for tumor content estimation, diagnosis correlation, and communication with referring pathologists and oncologists if discrepancies arise.
Participation in the quality management system, management of adverse outcomes and non-conformities, participation in onsite surveys, appropriate management of the results of the on-site survey, and performance in proficiency testing.
Provide oversight of all aspects of the laboratory's quality management system to ensure conformance to requirements described in the Quality Management System chapter of the Clinical Laboratory Practice Standards.
Provide continuing education to laboratory technical staff that is relevant to laboratory medicine.
Ensure that policies and procedures are established for monitoring staff to assess competency and, whenever necessary, provide remedial training or continuing education to improve skills.
Promote a safe laboratory environment for personnel and the public.
Ensure that an approved procedure manual is available to all personnel.
Monitor all work performed in the laboratory to ensure that medically reliable data are generated.
Assure that the laboratory participates in monitoring and evaluating the quality and appropriateness of services rendered, within the context of the Quality Management System, regardless of where the testing is performed.
Provide advice to referring physicians regarding the significance of laboratory findings and ensure that reports of test results include pertinent information required for specific patient interpretation.
Effectively implement a plan of correction for deficiencies identified.
Report all concerns of test quality and/or safety to Supervisor or Safety Officer.
Review and approve laboratory documentation such as policies and procedures, validation plans and reports, training and competency assessments, and reagent/control/instrument qualifications, quality audits, deviation approval requests, and nonconforming event reports.
Requirements
Must be a licensed physician in North Carolina (or be eligible for licensure).
Must possess training and demonstrated expertise in histopathology, obtained within the previous six years, in generally accepted and currently used methods and techniques in one or more categories listed below, and must meet one of the following requirements:
Be a physician who is currently certified by the American Board of Pathology in Anatomic Pathology and Clinical Pathology and preferably an area of special competence relevant to molecular genetics.
Must be qualified for New York State in the categories of Oncology and Histopathology or able to obtain said qualification.
Board certification by the American Board of Pathology in Molecular Genetic Pathology, or equivalent, is a plus.
Benefits
• Competitive Compensation and company wide benefits plan
• Opportunities for career advancement and professional development.
• A collaborative and innovative work environment dedicated to improving oncology outcomes.
SAGA Diagnostics is an equal opportunity employer, fully committed to achieving a diverse and inclusive workplace that embraces and encourages applicants of every background. The company's policy regarding equal employment opportunity means that all decisions regarding recruitment, hiring, benefits, wage and salary administration, scheduling, disciplinary action and termination will be made without unlawful discrimination on the basis of sex, gender, race, color, age, national origin, religion, disability, medical condition, genetic information, marital status, sexual orientation, gender identity or expression, citizenship status, pregnancy or maternity, veteran status, or any other status protected by applicable federal, state or local law. If you require reasonable accommodation in completing an application, interviewing, or otherwise participating in the employee selection process, please direct your inquiries to **********************. SAGA Diagnostics is a participant in the E-Verify program, learn more about the program and review our required disclosures
here
and
here
.
Medical Director
Medical director job in Lillington, NC
Job DescriptionAbout Lillington Veterinary Hospital Since 1985, Lillington Veterinary Hospital has been a cornerstone of pet care in Harnett County, delivering trusted, high-quality veterinary services with heart. We are a full-service small animal hospital where every day brings the chance to make a real difference for pets, their families, and each other. Our passionate team thrives in a supportive, upbeat environment where collaboration, growth, and compassion are at the core of everything we do. Whether it is preventive care, diagnostics, or surgery, we approach each case with dedication and a personal touch. If you are looking to join a practice with deep community roots and a forward-thinking spirit, you will feel right at home here.
The Opportunity
We are looking for a Medical Director who is excited to lead, inspire, and shape the future of our hospital. In this role, you will guide a passionate team, uphold our tradition of exceptional care, and help define our vision for the years ahead. This opportunity allows you to blend hands-on medicine with mentorship and leadership, making a meaningful impact on both daily patient care and the long-term growth of a thriving, community-focused hospital.
If you are ready to bring your expertise and leadership to a practice that values innovation, teamwork, and community, we would love to meet with you!
Why Join Us?
Benefits that Support You: Enjoy fully paid maternity leave, a generous sign-on bonus, relocation assistance, and competitive compensation, with no negative accrual and no non-competes.
Balance That Works: We believe in creating space for you to thrive both in and out of the clinic, with a schedule and environment that supports your well-being and professional growth.
A Culture That Connects: From team-building activities and book club to our compassionate care budget, we foster a workplace where connection, creativity, and support are part of everyday life.
Make a Meaningful Impact: Be part of a team that delivers exceptional care to a vibrant and diverse community, where your work truly makes a difference.
Tired of the application process? Email your resume directly to Ryan Miller at ******************************!
About You
You're a licensed veterinarian in North Carolina who's passionate about practicing high-quality, evidence-based medicine. You thrive in a collaborative environment, value clear communication, and are ready to take on a leadership role where your experience and insight can truly shape the future of a veterinary hospital.
EverVet Community
Our hospital is a proud member of the EverVet family of hospitals. EverVet's community is one of vision, energy, collaboration and support - we're like-minded professionals who are driven by the desire to truly make a difference for pets and pet parents. We lift each other up and are not afraid to challenge convention and create a unique space in the veterinary acquisition market.
We recognize that the veterinary profession is changing rapidly, but our entrepreneur-guided ownership model and commitment to building healthy, thriving practices has led to industry leading DVM and support staff retention.
The Benefits Highlights:
EverVet covers:
The majority of Medical for individual and dependents (exact percentages vary by tier of coverage chosen).
75% of premiums for Dental and Vision for individual and dependents.
100% of premiums for Short-Term Disability and Life/AD&D.
$250 match towards any employee contributions into an accompanying HSA Plan if they select the High-Deductible plan.
Safe Harbor 401(k) plan up to 4%.
The Benefits Breakdown:
Career:
State License Reimbursement
DEA License Reimbursement
AVMA Membership
State VMA Membership
VIN Membership
Competitive Pay
Generous Annual Continuing Education Allowance
Access to Zoetis Clinical & Professional Program and Events including Conquering Dentistry, Intro to Ultrasound, FRANK Training, Business Bootcamps, (subsidized up to $4,500)
Access to a multitude of VMG resources including VMG national events & CE
Health & Family:
Medical
Dental
Vision
Short-term Disability
Long-term Disability
Supplemental Life
Paid Time Off
Employee Pet Discount
Maternity Leave
Bereavement Leave
Financial:
401(k) with Generous Employer Match
Competitive Sign-on Bonus
Comprehensive PTO Program
Discounted Veterinary Care
Health Savings Account
Group Life and AD&D
Supplemental Life Insurance
Disability Insurance
The Softer Stuff:
Employee Assistant Program available 24 hours a day, 7 days a week.
Practice Managers and Doctors have access to Facebook Workplace, a robust networking tool that allows you to easily collaborate with your complete network of EverVet peers. After all, we're better together!
Easy ApplyVeterinarian, Medical Director
Medical director job in Cary, NC
at Kildaire Animal Medical Center
Veterinarian - Medical Director Full Time Kildaire Animal Medical Center About You As a key leader in our hospital, you'll drive positive change and growth. Your influence will shape our vision, foster an exceptional culture, and maintain high standards of care. Partnering with the practice manager and leadership team, you'll develop strategies, implement improvements, and guide our hospital toward excellence in patient and client care while supporting staff development. Experience & Skills Requirements
Doctor of Veterinary Medicine (DVM / VMD) or equivalent degree required.
State Veterinary Board License in good standing for the state of hire prior to start date.
Active DEA license or DEA licensure eligible. Kildaire Animal Medical Center is looking for a Veterinarian Medical Director to join our team as part of the Thrive Pet Healthcare community. At Kildaire Animal Medical Center, a Thrive Pet Healthcare partner, you will have the support, tools, and resources to elevate your skills. As a hospital deeply rooted in the local community, you'll experience the best of both worlds: a genuine local feel with the benefits of Thrive's national resources.
About the Hospital
At Kildaire Animal Medical Center, we are dedicated to providing compassionate, high-quality veterinary care to the pets and families of Cary, North Carolina. Our team understands that pets are family, which is why we combine advanced medical services with a warm, welcoming environment. From preventive wellness and dentistry to diagnostics and surgery, we strive to meet every pet's unique needs with skill and kindness. Whether it's a routine check-up or specialized care, our mission is to support lifelong health and strengthen the bond you share with your pet.
We are open Monday 7:30 AM-8 PM, Tuesday-Friday 7:30 AM-6 PM, Saturday 9 AM-1 PM, and closed on Sunday.
Provide your best care as a Thrive Pet Healthcare veterinarian. Support and mentor veterinarians at your hospital toward achieving medical excellence and enhancing patient outcomes through close collaboration with practice managers and hospital leadership. With comprehensive support, you'll be empowered to perform at your best. Access leadership training and mentorship programs to develop your skills and advance your career.The success of your patients' care matters to you, and your success matters to us. Our progressive compensation model includes competitive base salaries with production opportunities - plus no negative accrual.
Benefits - our care in action
Thrive offers a suite of benefits to support team members' emotional, physical, professional, and financial wellbeing. In addition to our health and life insurance, and short- and long-term disability plans, we offer eligible team members:
Competitive pay
Medical Director stipend
401(k) with employer match
Mental health resources, including 24/7 access to Lyra Health
Paid parental and purr-ental leave
Employer-sponsored childcare and elder care
Personalized care for every family-forming journey
Discretionary funds and FREE CE courses
Pet perks and veterinary service discounts
Student loan management tools and assistance
Thrive's Medical Excellence and Education Department leads training and mentorship programs to empower you with the knowledge, tools, and resources to grow your career - whether you're a Vet Technician, Doctor, or in Hospital Leadership. We also offer an innovative Medical Leadership Program that equips you with skills in leadership, hospital operations, and medical excellence. Through self-paced learning, live presentations, and a 1:1 mentor buddy, we ensure our medical leaders have the support they need to excel.
To learn more about this amazing opportunity, apply today or reach out to us at [email protected].
About Thrive
Vet-founded and Austin-born, Thrive Pet Healthcare has expanded to over 380 partner hospitals nationwide, united by a mission to shape the future of pet well-being through medical excellence, innovative technology, and a connected community. We bridge general practice, urgent care, specialty, and emergency care, and our locally rooted, nationally connected hospitals benefit from Thrive's resources while maintaining their unique identities.
We believe that supporting our people is the key to helping pets thrive through every stage of life. Join us where #WeThriveTogether. We provide customizable professional development opportunities, a supportive work environment that values work-life rhythms, and 24/7 mental health support.
At Thrive Pet Healthcare, we are committed to creating a culture where everyone from any background can be heard, respected, and valued. We pledge to build an inclusive environment nurtured by respectful curiosity to support, encourage, and celebrate the diverse voices of our teams and the communities we serve.
Auto-ApplyMedspa Medical Director (North Carolina)
Medical director job in Cary, NC
At Moxie, we empower ambitious aesthetic entrepreneurs to build profitable, independent practices-without burnout, overwhelm, or guesswork. In just a few years, we've grown from an idea to a global, remote-first team of more than 140 people, supporting hundreds of practices nationwide.
Our purpose is simple: to unlock sustainable success for aesthetic entrepreneurs, at every stage of their journey.
**Must reside or have a primary office in North Carolina, and hold an active NC license.
We work with talented nurse injectors to empower them to build independent businesses. We help connect Medical Directors to RN, NP, and PA providers, to provide insight into state regulations and standards of care.
Our providers work through our software platform which streamlines administrative tasks to allow you to focus on medical partnership:
Approving all medical hires
Approving treatment menus (Botox, fillers, lasers, etc.)
Reviewing and signing protocols, SOPs, and consent forms
Completing monthly chart reviews (10%+ of appointments)
Being available for emergency
Provide general supervision according to state law
Be available for consultations and decision-making support
Once vetted, you will have the opportunity to interview and select the injectors you'd like to partner with, at the rates you determine. You may work with as many injectors as you choose, in accordance with state law.
Requirements:
Active North Carolina Medical License
Must currently reside in North Carolina
MDs with backgrounds in Plastic Surgery or Dermatology preferred
Experienced MDs with any aesthetic background who have mid-level capacity
Previous experience serving as a Medical Director in a medspa or aesthetic practice.
Formal training with injectables and other aesthetic services
Willingness to oversee aesthetics treatments
Interest in supporting RNs, PAs, and NPs
Benefits:
Pay & Perks
$5,000 SIGNING BONUS
Competitive compensation
Liability is covered
Minimal time commitment: 1-2 hours per month per provider.
Operational support: Moxie manages admin, billing, and documentation.
Other Info:
This is a PC owner position - Moxie manages everything on your behalf for the PC
Experience in either Dermatology, Plastic Surgery, Ophthalmology, or Oculoplastic Surgery is a plus
We're specifically looking for Medical Directors licensed to practice in North Carolina.
Job Type: Contract
Work Location: Remote
Why Join Moxie as a North Carolina MD?
By joining Moxie, you step into a role that balances clinical leadership with lifestyle flexibility. You will:
Lead the clinical direction of your assigned medspas.
Enjoy robust operational and administrative support.
Earn strong, predictable income
Contribute to redefining excellence in medspa management across North Carolina.
At Moxie, we believe in creating a workplace where everyone feels valued, trusted, and included. Our team lives by our values: act as owners, give more than we take, move with speed and care, and simplify and learn every day.
We welcome people of all backgrounds, experiences, and perspectives to apply. If you require any accommodations to fully participate in the interview process, please let us know, we're happy to assist.
Auto-ApplyDirector of Nursing
Medical director job in Roxboro, NC
We are currently recruiting a full-time Director of Nursing for a facility within the Roxboro, NC area. Position offers a competitive salary with a robust recruitment package. The Director of Nursing is directly accountable for all patient care activities performed within the facility on a 24-hour basis. Provides direction, supervision, and evaluation of all patient care. Organizes and implements management systems, facility policies, procedures, and programs. Coordinates Nursing Service activities with facility administration, community agencies, physician, families, consultant personnel, and ancillary service personnel. Assumes responsibility for nursing service compliance to federal, state, and local regulations. Performs other work of the department and is responsible for assigned sections on a 24 hours basis.
Responsibilities of the Position:
Assesses the resident's condition and nursing care needs; plans care and defines appropriate nursing interventions to meet those plans of care and the physical, psychological, social and rehabilitative needs of the resident, including discharge planning.
Develops individualized nursing care plans for assigned residents.
Implements care plans and makes revisions accordingly.
Evaluates resident outcomes.
Collaborates with physicians and other members of the health care team.
Coordinates resident care, admissions, transfers, and discharges.
Defines the mission for the department and shares the corporate vision with assigned staff.
Directs operations and administration of the department under the general guidance of the facility Administrator.
Develops and directs assigned personnel in the performance of their duties and responsibilities.
Communicates, coordinates and/or collaborates with Administrator, other staff and management personnel, physicians, peers, outside officials, vendors, and consultants with regard to departmental and corporate activities and issues.
Oversees the procurement, sets up, use and/or maintenance of equipment, supplies, and work areas.
Oversees/maintains skill competences and assumes responsibility for professional development and on-going education.
Other tasks and duties as assigned.
Qualifications - External
Minimum Education:
Bachelor's degree in nursing is required.
Two to three years of professional nursing experience with one year in supervisory experience is required.
North Carolina or Compact State RN License required.
Certifications/Licenses:
Certifications: Basic Life Support (BLS) is required through American Heart Association upon hire.
Associate Director, Medical Omnichannel Data Scientist
Medical director job in Raleigh, NC
**About Otsuka** We defy limitation, so that others can too. In going above and beyond-under any circumstances-for patients, families, providers, and for each other. It's this deep-rooted dedication that drives us to uncover answers to complex, underserved medical needs, so that patients can push past the limitations of their disease and achieve more than they thought was possible each day.
**About the Role**
The Omnichannel Center of Excellence is dedicated to driving innovation, building, and delivering capabilities that enhance Otsuka's opportunity to make an impact in the lives of those we serve. We achieve this through our relentless focus on customer centricity, patient empathy, expertise in enabling pathways for disease education and awareness of management options, and our unwavering commitment to supporting access to treatment.
We are looking for an **Omnichannel Data Scientist** , **Medical Omnichannel** with strong expertise in artificial intelligence, encompassing machine learning, data mining, and information retrieval. This position specifically entails the conceptualization, prototyping and development of next generation advanced analytics model-based decision engines and services. The ideal candidate will engage closely with key stakeholders to understand strategic objectives and leverage advanced data analytics and machine learning techniques to enhance communication strategies, ensuring seamless and personalized interactions with healthcare professionals (HCPs) and key opinion leaders (KOLs).
**Job Expectations/Responsibilities:**
**Data Integration & Management**
+ Explore and analyze common pharmaceuticals data (e.g., claims) as well as novel data sets based on lab and EHR systems. Work with Omnichannel Data Engineer to Integrate data from multiple sources (e.g., CRM systems, social media, email platforms) to create a unified view of stakeholder interactions.
+ Apply natural language processing (NLP) to extract insights from unstructured medical texts, such as clinical notes or call center transcripts.
+ Identifying relevant data drivers (features) that can inform decision making closely tied with strategy and creating visualizations to help communicate findings.
**Advanced Analytics & Modeling**
+ Implement advanced analytics models, including predictive analytics and clustering algorithms, to generate actionable insights and track trends across various channels.
+ Work with Omnichannel ML/Ops engineer to build, test, and deploy production-grade predictive models and algorithms as part of the Omnichannel COE decision engine to meet business needs, including optimization of sales activities and predicting drivers of customer behavior.
+ Create repeatable, interpretable, dynamic, and scalable models that are seamlessly incorporated into analytic data products and match the needs of Otsuka's growing portfolio.
+ Collaborate on MLOPS life cycle experience with MLOPS workflows traceability and versioning of datasets. Build and maintain familiarity with Otsuka Machine Learning tech stack including AWS, Kubernetes, Snowflake, and Dataiku
**Omnichannel Optimization**
+ Design and deploy recommendation systems to tailor communications based on stakeholder preferences and behaviors. Utilize machine learning algorithms (e.g., collaborative filtering, content-based filtering) to enhance personalization efforts.
+ Analyze the performance of omnichannel campaigns (email, SMS, in-app, HCP portals, etc.) to identify high-impact touchpoints and optimize engagement strategies. Use A/B testing and uplift modeling to evaluate the effectiveness of different communication strategies and content types.
**Stakeholder Collaboration**
+ Effectively communicating analytical approach to address strategic objectives to business partners.
+ Work closely with medical affairs, marketing, and IT teams to ensure alignment and integration of omnichannel strategies. Provide technical guidance and support to cross-functional teams on data-related projects.
+ Stay updated with emerging industrial trends (Conferences and community engagement) and develop strategic industry partnerships on Omnichannel analytics to strengthen Otsuka's analytical methods and outcomes.
+ Model Otsuka's core competencies (Accountability for Results, Strategic Thinking & Problem Solving, Patient & Customer Centricity, Impact Communications, Respectful Collaboration & Empowered Development) that define how we work together at Otsuka. Key matrixed partners included: Brand Marketing, Creative / CRM / Digital agencies, Media, Market Research, Analytics, Otsuka Information Technology (OIT), Sales Operations, and Medical/Regulatory/Legal integrated business partners.
**Minimum Qualification:**
+ Bachelor's degree in data sciences, computer science and 4-6 years of relevant experience
**Preferred Knowledge, Skills, and Abilities:**
+ Demonstrated experience with scripting and implementing data analytics algorithms and models. Hands on experience using a modeling and simulation software (e.g. Python, Matlab, R, NONMEM, SAS, S-Plus, etc.) is a plus.
+ Knowledge/Experience in the usage of machine learning/AI tools in life science area(s) and handling life science datasets is preferred.
+ Excellent interpersonal, technical, and communication skills to lead cross-functional teams.
+ Profound grasp of Machine Learning lifecycle - feature engineering, training, validation, scaling, deployment, scoring, monitoring, and feedback loop.
+ Have implemented machine learning projects from initiation through completion with particular focus on automated deployment and ensuring optimized performance.
+ Agile skills and experience
+ Experience in Healthcare (esp. US) industry is a plus.
**Competencies**
**Accountability for Results -** Stay focused on key strategic objectives, be accountable for high standards of performance, and take an active role in leading change.
**Strategic Thinking & Problem Solving -** Make decisions considering the long-term impact to customers, patients, employees, and the business.
**Patient & Customer Centricity -** Maintain an ongoing focus on the needs of our customers and/or key stakeholders.
**Impactful Communication -** Communicate with logic, clarity, and respect. Influence at all levels to achieve the best results for Otsuka.
**Respectful Collaboration -** Seek and value others' perspectives and strive for diverse partnerships to enhance work toward common goals.
**Empowered Development -** Play an active role in professional development as a business imperative.
Minimum $164,530.00 - Maximum $245,985.00, plus incentive opportunity: The range shown represents a typical pay range or starting pay for individuals who are hired in the role to perform in the United States. Other elements may be used to determine actual pay such as the candidate's job experience, specific skills, and comparison to internal incumbents currently in role. Typically, actual pay will be positioned within the established range, rather than at its minimum or maximum. This information is provided to applicants in accordance with states and local laws.
**Application Deadline** : This will be posted for a minimum of 5 business days.
**Company benefits:** Comprehensive medical, dental, vision, prescription drug coverage, company provided basic life, accidental death & dismemberment, short-term and long-term disability insurance, tuition reimbursement, student loan assistance, a generous 401(k) match, flexible time off, paid holidays, and paid leave programs as well as other company provided benefits.
Come discover more about Otsuka and our benefit offerings; ********************************************* .
**Disclaimer:**
This job description is intended to describe the general nature and level of the work being performed by the people assigned to this position. It is not intended to include every job duty and responsibility specific to the position. Otsuka reserves the right to amend and change responsibilities to meet business and organizational needs as necessary.
Otsuka is an equal opportunity employer. All qualified applicants are encouraged to apply and will be given consideration for employment without regard to race, color, sex, gender identity or gender expression, sexual orientation, age, disability, religion, national origin, veteran status, marital status, or any other legally protected characteristic.
If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation, if you are unable or limited in your ability to apply to this job opening as a result of your disability. You can request reasonable accommodations by contacting Accommodation Request (EEAccommodations@otsuka-us.com) .
**Statement Regarding Job Recruiting Fraud Scams**
At Otsuka we take security and protection of your personal information very seriously. Please be aware individuals may approach you and falsely present themselves as our employees or representatives. They may use this false pretense to try to gain access to your personal information or acquire money from you by offering fictitious employment opportunities purportedly on our behalf.
Please understand, Otsuka will **never** ask for financial information of any kind or for payment of money during the job application process. We do not require any financial, credit card or bank account information and/or any payment of any kind to be considered for employment. We will also not offer you money to buy equipment, software, or for any other purpose during the job application process. If you are being asked to pay or offered money for equipment fees or some other application processing fee, even if claimed you will be reimbursed, this is not Otsuka. These claims are fraudulent and you are strongly advised to exercise caution when you receive such an offer of employment.
Otsuka will also never ask you to download a third-party application in order to communicate about a legitimate job opportunity. Scammers may also send offers or claims from a fake email address or from Yahoo, Gmail, Hotmail, etc, and not from an official Otsuka email address. Please take extra caution while examining such an email address, as the scammers may misspell an official Otsuka email address and use a slightly modified version duplicating letters.
To ensure that you are communicating about a legitimate job opportunity at Otsuka, please only deal directly with Otsuka through its official Otsuka Career website ******************************************************* .
Otsuka will not be held liable or responsible for any claims, losses, damages or expenses resulting from job recruiting scams. If you suspect a position is fraudulent, please contact Otsuka's call center at: ************. If you believe you are the victim of fraud resulting from a job recruiting scam, please contact the FBI through the Internet Crime Complaint Center at: ******************* , or your local authorities.
Otsuka America Pharmaceutical Inc., Otsuka Pharmaceutical Development & Commercialization, Inc., and Otsuka Precision Health, Inc. ("Otsuka") does not accept unsolicited assistance from search firms for employment opportunities. All CVs/resumes submitted by search firms to any Otsuka employee directly or through Otsuka's application portal without a valid written search agreement in place for the position will be considered Otsuka's sole property. No fee will be paid if a candidate is hired by Otsuka as a result of an agency referral where no pre-existing agreement is in place. Where agency agreements are in place, introductions are position specific. Please, no phone calls or emails.
Sr. Pathologist and Associate Medical Director
Medical director job in Morrisville, NC
About the Job The Sr Pathologist and Associate Medical Director is involved in all aspects of delivering Foundation Medicine's clinical laboratory testing services and serves as an internal subject matter expert, applying medical knowledge to advise decision makers in support of Foundation Medicine's mission to transform cancer care. The Sr Pathologist is responsible for review of patient samples, review of results generated from genomic profiling and other methodologies, and approval of reports. As an Associate Medical Director, the Sr Pathologist develops, reviews, and approves policies and procedures to ensure consistent, timely, and accurate clinical testing strategies; and participates in instrument, IT and test methodology selection, qualification and documentation; as well as new assay development, validation, and operationalization. The incumbent also serves as an ambassador for comprehensive genomic profiling through education and research efforts within and external to Foundation Medicine's.
This is a regulated position and additional information may be available from QA on the qualifications for this role pertaining to regulatory guidelines.
Key Responsibilities
* For clinical and biopharma testing performed at Foundation Medicine:
* Review patient specimens and accompanying documentation prior to testing in collaboration with other applicable stakeholders.
* Review test results and approve reports.
* As appropriate for the role, testing may include FoundationOne CDx, FoundationOne Heme, FoundationOne RNA, FoundationOne LiquidCDx, FoundationOne Tracker, and/or PD-L1 IHC assays, among others.
* Function as an Associate Medical Director for the laboratory operations to ensure compliance with regulatory guidelines and promote audit readiness.
* Interface directly with clients to support patient care.
* Support Foundation Medicine's Commercial Team initiatives and programs through traveling to and administering programs at hospitals, cancer centers, and academic medical centers.
* Participate in new assay development and validation, and optimization of existing assays.
* Provide clinical expertise for strategic research initiatives to expand new testing capabilities.
* Support Quality Assurance, Compliance, and Regulatory activities.
* Perform research studies leading to abstracts, peer-reviewed publications, and presentations at medical/scientific meetings that highlight Foundation Medicine's assays and data.
* Provide subject matter expertise on established specialty areas.
* May independently manage direct reports, including Senior Pathologists, Pathologists, and Clinical Staff Pathologists in the execution of the pathology clinical services, and support their career development and growth.
* Other duties as assigned.
Qualifications:
Basic Qualifications:
* Doctor of Medicine Degree
* Medical Licensure in the state of primary clinical laboratory affiliation
* Formal pathology training
* American Board of Pathology - Anatomic Pathology Certification
* 3+ years of experience in diagnostic pathology, biomedical research, or biotechnology after completion of clinical training
Preferred Qualifications:
* American Board of Pathology - Clinical Pathology Certification
* American Board of Pathology - Molecular Genetic Pathology Certification
* Subspecialty training and/or expertise in cancer biology, genomics, or clinical trials
* Strong history of achievement demonstrated by leadership activities, publications, presentations, or other activities
* Collaboration skills and ability to effectively communicate with internal and external team members
* Process-oriented, flexible mindset and approach to creative problem solving
* Demonstrated history of cross-functional leadership and/or participation in cross-functional teams
* Demonstrated ability to:
* Meet deadlines
* Work well under pressure while maintaining a professional demeanor
* Self-organize and operate effectively without day-to-day oversight, while staying tightly connected to key leaders and teams across the collaborations
* Work in a laboratory environment in the presence of chemicals and reagents
* Agreement to maintain confidentiality regarding sensitive company, employee, and proprietary data and information
* Commitment to reflect Foundation Medicine's values: Integrity, Courage, and Passion
The expected salary range for this position based on the primary location of Morrisville, NC is $250,000 - $310,000 per year. The salary range is commensurate with Foundation Medicine's compensation practice and considers factors including, but not limited to, education, training, experience, external market conditions, criticality of role, and internal equity. A discretionary annual bonus may be available based on individual and Company performance. This position also qualifies for Foundation Medicine's benefits.
#LI-Onsite
PCO Medical Director - UM - Part Time (Hourly)
Medical director job in Raleigh, NC
**Become a part of our caring community and help us put health first** The Medical Director, Primary Care relies on medical background and reviews health claims. The Medical Director, Primary Care work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.
The Medical Director relies on medical background and reviews health claims. The Medical Director work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.
The Medical Director actively uses their medical background, experience, and judgement to make determinations whether requested services, requested level of care, and/or requested site of service should be authorized. All work occurs with a context of regulatory compliance, and work is assisted by diverse resources which may include national clinical guidelines, CMS policies and determinations, clinical reference materials, internal teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and Medicare Advantage requirements and will understand how to operationalize this knowledge in their daily work.
The Medical Director's work includes computer-based review of moderately complex to complex clinical scenarios, review of all submitted clinical records, prioritization of daily work, communication of decisions to internal associates, participation in care management and possible participation in care facilitation with hospitals. The clinical scenarios predominantly arise from inpatient or post-acute care environments. There are discussions with external physicians by phone to gather additional clinical information or discuss determinations regularly, and in some instances, these may require conflict resolution skills. An aspect of the role includes an overview of coding practices and clinical documentation, grievance and appeals processes, and outpatient services and equipment, within their scope.
The Medical Director may speak with contracted external physicians, physician groups, facilities, or community groups to support regional market care facilitation and priorities, which may include an understanding of Humana processes, as well as a focus on collaborative business relationships, value-based care, population health, or disease or care management.
**Use your skills to make an impact**
**Responsibilities**
The Medical Director provides medical interpretation and determinations whether services provided by other healthcare professionals are in agreement with national guidelines, CMS requirements, Humana policies, clinical standards, and (in some cases) contracts. The ideal candidate supports and collaborates with other team members, other departments, Humana colleagues and the Regional VP Health Services. After completion of mentored training, daily work is performed with minimal direction. Enjoys working in a structured environment with expectations for consistency in thinking and authorship. Exercises independence in meeting departmental expectations and meets compliance timelines.
**Required Qualifications**
+ MD or DO degree.
+ 5+ years of direct clinical patient care experience post residency or fellowship, which preferably includes some experience in an inpatient environment and/or related to care of a Medicare type population (disabled or >65 years of age).
+ Current and ongoing Board Certification in an approved ABMS Medical Specialty as well as ABQAURP, or other boarddemonstratingadvanced training in transitions of care, quality assurance,utilizationmanagementand care coordination.
+ A current and unrestricted license in at least onejurisdictionand willing to obtainadditionallicense, ifrequired.
+ No currentsanctionfrom Federal or State Governmental organizations, and able to pass credentialing requirements.
+ Excellent organizational,verbaland written communication skills.
+ Evidence of analytic and interpretation skills, with prior experienceparticipatingin teams focusing on transitions of care, quality management,utilizationmanagement, case management, discharge planning and/or home health or post-acute services such as inpatient rehabilitation.
**Preferred Qualifications**
+ Knowledge of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other medical management organizations, hospitals/ Integrated Delivery Systems, health insurance, other healthcare providers, clinical group practice management.
+ Utilizationmanagement experience in a medical management review organization, such as Medicare Advantage,managed Medicaid, or Commercial health insurance.
+ Experience with national guidelines such as MCG or InterQual.
+ Internal Medicine, Family Practice, Geriatrics, Hospitalist, Emergency Medicine clinical specialists
+ Advanceddegreesuch as an MBA, MHA, MPH
+ Exposure to value-based care, Public Health, Population Health, analytics, and use of business metrics.
+ Experience working with Casemanagersor Caremanagerson complex case management, including familiarity with social determinants of health.
+ The curiosity to learn, the flexibility toadaptand the courage to innovate.
**Additional Information**
Will report to the Director of Physician Strategy at Utilization Management. The Medical Director conducts Utilization review of the care received by members in an assigned region, market, member population, or condition type. May also engage in grievance and appeals reviews. May participate on project teams or organizational committees.
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
**Scheduled Weekly Hours**
1
**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.
$223,800 - $313,100 per year
**Description of Benefits**
Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers benefits for limited term, variable schedule and per diem associates which are designed to support whole-person well-being. Among these benefits, Humana provides paid time off, 401(k) retirement savings plan, employee assistance program, business travel and accident.
Application Deadline: 12-31-2025
**About us**
About Conviva Senior Primary Care: Conviva Senior Primary Care provides proactive, preventive care to seniors, including wellness visits, physical exams, chronic condition management, screenings, minor injury treatment and more. As part of CenterWell Senior Primary Care, Conviva's innovative, value-based approach means each patient gets the best care, when needed most, and for the lowest cost. We go beyond physical health - addressing the social, emotional, behavioral and financial needs that can impact our patients' well-being.
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 *************************************************************
Medical Director-Dermatology Appeals
Medical director job in Durham, NC
Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be considered. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.
The Medical Director-Dermatology Appeals is responsible for the review of appeals for physical health medical services, to ensure the appropriate and most cost-effective medical care is received. May be responsible for developing and implementing programs to improve quality, cost, and outcomes. May provide clinical consultation and serve as clinical/strategic advisor to enhance clinical operations. May identify cost of care opportunities. May serve as a resource to staff including Medical Director Associates. May be responsible for an entire clinical program.
How you will make an impact:
* Complete appeal reviews in your specialty daily to ensure timely and consistent responses to members and providers.
* Provide guidance for clinical operational aspects of a program.
* May conduct peer-to-peer clinical reviews with attending physicians or other providers to discuss review determinations
* Serve as a resource and consultant to other areas of the company.
* May be required to represent the company to external entities and/or serve on internal and/or external committees.
* May chair company committees.
* Interpret medical policies and clinical guidelines.
* May lead, develop, direct, and implement clinical and non-clinical activities that impact health care quality cost and outcomes.
* Identify and develop opportunities for innovation to increase effectiveness and quality.
* Work independently with oversight from immediate manager.
* May be responsible for an entire clinical program and/or independently perform clinical reviews.
Minimum Qualifications
* Requires MD or DO and Board certification approved by one of the following certifying boards is required, where applicable to duties being performed: American Board of Medical Specialties (ABMS) or American Osteopathic Association (AOA).
* Board certification in Dermatology.
* Must possess an active unrestricted medical license to practice medicine or a health profession. Unless expressly allowed by state or federal law, or regulation, must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US military base, vessel or any embassy located in or outside of the US.
* Minimum of 10 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
* For Health Solutions and Carelon organizations (including behavioral health) only, minimum of 5 years of experience providing health care is required.
* Additional experience may be required by State contracts or regulations if the Medical Director is filling a role required by a State agency.
* For URAC accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written, and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills. If this job is assigned to any Government Business Division entity, the applicant and incumbent fall under a sensitive position work designation and may be subject to additional requirements beyond those associates outside Government Business Divisions. Requirements include but are not limited to more stringent and frequent background checks and/or government clearances, segregation of duties, principles, role specific training, monitoring of daily job functions, and sensitive data handling instructions. Associates in these jobs must follow the specific policies, procedures, guidelines, etc. as stated by the Government Business Division in which they are employed.
Job Level:
Director Equivalent
Workshift:
Job Family:
MED > Licensed Physician/Doctor/Dentist
Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Who We Are
Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
How We Work
At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ******************************************** for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
CLIA Laboratory and Medical Director (relocation offered to Raleigh, NC area)
Medical director job in Morrisville, NC
SAGA Diagnostics is a personalized cancer diagnostics and disease monitoring company focused on molecular genetic analysis of circulating tumor DNA (ct DNA). The company's mission is to improve precision cancer medicine, provide more accurate treatment monitoring, and improve patient survival using minimally invasive liquid biopsy cancer testing services. SAGA's proprietary tests can help patients, oncologists, and drug developers detect actionable mutations, stratify patient groups, and monitor treatment response, residual disease, and disease recurrence at unprecedented sensitivity and scale. SAGA Diagnostics recently established a US operation in Research Triangle Park (RTP) and is excited to invite you to join our dedicated team.
The CLIA Laboratory and Medical Director is responsible for ensuring the delivery of quality clinical laboratory services. This position will serve as the CLIA Laboratory Director and be listed on the CLIA license. Specific responsibilities will include histology slide assessment, tissue selection, molecular assay interpretation and sign-out, assay development and validation, participation in laboratory operations, and improving digital pathology capabilities.
Essential Duties and Responsibilities:
* Responsibilities in operating the histopathology laboratory under CLIA, CAP, NYS, and all other applicable regulations.
* Responsible for slide review for tumor content estimation, diagnosis correlation, and communication with referring pathologists and oncologists if discrepancies arise.
* Participation in the quality management system, management of adverse outcomes and non-conformities, participation in onsite surveys, appropriate management of the results of the on-site survey, and performance in proficiency testing.
* Provide oversight of all aspects of the laboratory's quality management system to ensure conformance to requirements described in the Quality Management System chapter of the Clinical Laboratory Practice Standards.
* Provide continuing education to laboratory technical staff that is relevant to laboratory medicine.
* Ensure that policies and procedures are established for monitoring staff to assess competency and, whenever necessary, provide remedial training or continuing education to improve skills.
* Promote a safe laboratory environment for personnel and the public.
* Ensure that an approved procedure manual is available to all personnel.
* Monitor all work performed in the laboratory to ensure that medically reliable data are generated.
* Assure that the laboratory participates in monitoring and evaluating the quality and appropriateness of services rendered, within the context of the Quality Management System, regardless of where the testing is performed.
* Provide advice to referring physicians regarding the significance of laboratory findings and ensure that reports of test results include pertinent information required for specific patient interpretation.
* Effectively implement a plan of correction for deficiencies identified.
* Report all concerns of test quality and/or safety to Supervisor or Safety Officer.
* Review and approve laboratory documentation such as policies and procedures, validation plans and reports, training and competency assessments, and reagent/control/instrument qualifications, quality audits, deviation approval requests, and nonconforming event reports.
Medical Director-Dermatology Appeals
Medical director job in Durham, NC
Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be considered. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.
The Medical Director-Dermatology Appeals is responsible for the review of appeals for physical health medical services, to ensure the appropriate and most cost-effective medical care is received. May be responsible for developing and implementing programs to improve quality, cost, and outcomes. May provide clinical consultation and serve as clinical/strategic advisor to enhance clinical operations. May identify cost of care opportunities. May serve as a resource to staff including Medical Director Associates. May be responsible for an entire clinical program.
How you will make an impact:
* Complete appeal reviews in your specialty daily to ensure timely and consistent responses to members and providers.
* Provide guidance for clinical operational aspects of a program.
* May conduct peer-to-peer clinical reviews with attending physicians or other providers to discuss review determinations
* Serve as a resource and consultant to other areas of the company.
* May be required to represent the company to external entities and/or serve on internal and/or external committees.
* May chair company committees.
* Interpret medical policies and clinical guidelines.
* May lead, develop, direct, and implement clinical and non-clinical activities that impact health care quality cost and outcomes.
* Identify and develop opportunities for innovation to increase effectiveness and quality.
* Work independently with oversight from immediate manager.
* May be responsible for an entire clinical program and/or independently perform clinical reviews.
Minimum Qualifications
* Requires MD or DO and Board certification approved by one of the following certifying boards is required, where applicable to duties being performed: American Board of Medical Specialties (ABMS) or American Osteopathic Association (AOA).
* Board certification in Dermatology.
* Must possess an active unrestricted medical license to practice medicine or a health profession. Unless expressly allowed by state or federal law, or regulation, must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US military base, vessel or any embassy located in or outside of the US.
* Minimum of 10 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
* For Health Solutions and Carelon organizations (including behavioral health) only, minimum of 5 years of experience providing health care is required.
* Additional experience may be required by State contracts or regulations if the Medical Director is filling a role required by a State agency.
* For URAC accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written, and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills. If this job is assigned to any Government Business Division entity, the applicant and incumbent fall under a sensitive position work designation and may be subject to additional requirements beyond those associates outside Government Business Divisions. Requirements include but are not limited to more stringent and frequent background checks and/or government clearances, segregation of duties, principles, role specific training, monitoring of daily job functions, and sensitive data handling instructions. Associates in these jobs must follow the specific policies, procedures, guidelines, etc. as stated by the Government Business Division in which they are employed.
Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Who We Are
Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
How We Work
At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ******************************************** for assistance.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
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