Director of Nursing - Emergency Department
Medical director job in Jackson, MS
Lead with Purpose in Emergency Nursing
Join a team where your leadership makes a lasting difference - every shift, every patient, every outcome. As the Director of Nursing for our Emergency Department, you'll guide an exceptional team of nurses and clinical professionals in delivering compassionate, high-quality care when it matters most. If you're an experienced ER nurse who thrives in a fast-paced environment and is driven by purpose, we invite you to bring your expertise and heart to St. Dominic.
The Nursing Director supervises and coordinates patient care services of one or more nursing units on a 24-hour basis. The Nursing Director ensures that physicians' orders are followed; ensures that patient conditions and progress are accurately reported; ensures that patient care is administered by all professional and nonprofessional personnel in the unit according to organization and regulatory policies and guidelines; and has staffing and budget control responsibilities for the unit.
Responsibilities
1. Leadership
a. Utilizes advanced clinical knowledge to develop and maintain a delivery system for individualized, appropriate, and compassionate patient care. Supports and encourages staff, patients, and significant others in the determination of treatment and rehabilitation goals for desired outcomes. Provides leadership and participates in emergency measures for sudden adverse patient developments.
b. Provides leadership and demonstrates critical thinking ability in all areas of responsibility, treats all co-workers with respect, strives to enhance co-worker performance through cooperation and effective communication, and demonstrates hospitality and courtesy in all interactions.
2. Unit Management and Daily Operations
a. Estimates future departmental personnel, equipment, and supply needs in order to ensure the attainment of operating goals. Develops, recommends, and implements the annual capital equipment, personnel, and operating budget for the department. Conducts periodic reviews of departmental performance, analyzes budget variances, and implements responsive action.
b. Demonstrates clinical expertise in facilitating the timely availability, access, and utilization of multidisciplinary health care services, alternative levels of care, and community resources in a manner that ensures optimal continuity and expediency in the health care delivery process.
c. Implements strategies that use current scientific knowledge to prevent and reduce the risk of infection transmission. Promptly and appropriately reports infections between and among staff, patients, and visitors in order to improve patient outcomes.
d. Consults with nursing management, nursing staff, and Clinical Nurse Specialists in the development of instructional materials for patients and family members which will provide the specific knowledge and skill required to increase their understanding of the patient's illness, meet the patient's ongoing health care needs, and improve patient health outcomes.
e. Develops and maintains documentation required for successful employee development and administrative and divisional communication. Supervises and participates in the efficient recording of pertinent patient care data utilizing the computerized medical record and manual documentation in order to promote timely and efficient access to required information throughout the organization. Preserves the confidentiality of data and information identified as sensitive in order to ensure the protection of patient dignity and privacy.
f. Monitors and coordinates the effective use, maintenance, and repair of equipment, supplies, facilities, and resources that support patient care in order to maintain a functional and safe environment for patients, staff, and visitors.
g. Maintains own clinical expertise and ensures the demonstrated clinical competency of staff members to deliver patient care services in accordance with the specific identified needs of adult and geriatric patients. Utilizes appropriate resources as needed for assistance in the planning and delivery of care to infant, pediatric, and adolescent patients.
3. Performance Improvement and Quality
a. Provides ongoing assessments of the patient care delivery system in order to identify existing and potential health care needs within the scope of care for the unit. Evaluates and makes recommendations for current and potential unit staffing needs, assesses and introduces technological and procedural changes that enhance the efficiency and quality of patient care services and outcomes, and supervises the ongoing assessment of patients for physical, psychological, and social status needs and discharge planning.
b. Coordinates and manages high quality health care services that recognize individual patient rights while acting as a role model for the nursing personnel. Educates staff and monitors care delivery in order to ensure that patients exercise their rights to be informed and to participate and make decisions in all aspects of their medical care. Ensures that patient care demonstrates respect for personal values and beliefs and is focused on the unique needs of each individual and their family.
c. Utilizes continued analysis and evaluation of patient care outcomes to enhance the quality and efficiency of services and optimize the utilization of hospital resources. Participates actively in unit-specific and multidisciplinary continuous quality improvement and quality assurance studies in a manner that promotes compliance with hospital and divisional regulations and standards.
d. Ensures that all staff members are oriented and continuously educated regarding their roles in sustaining and improving the overall environment. Assesses the learning and development needs of staff members and is responsible for the provision of appropriate educational services.
e. Establishes departmental standards for the evaluation of personnel performance and monitors the performance of reporting personnel. Promotes and encourages the growth and development of staff members by encouraging their participation in approved continuing education activities such as professional conferences, seminars, and workshops. Advocates continuing education as a means of promoting the high quality services provided by all departmental personnel.
f. Observes and adheres to all departmental and hospital policies and procedures, and follows all safety, quality assurance, and infection control standards.
4. Other Duties As Assigned
Job Requirements
Education - Bachelors of Science in Nursing
Licensure: Current licensure in good standing in the state of Mississippi; Current BLS required. ACLS preferred.
Assistant Director of Nursing
Medical director job in Jackson, MS
Advance Your Nursing Leadership Career as an Assistant Director of Nursing (RN) at Diversicare of Shelby in Shelby, MS!
Are you an experienced RN with a passion for leadership and a drive for excellence in healthcare? Diversicare, a leading provider of post-acute care services, invites you to take the next step in your nursing career as our Assistant Director of Nursing.
Why Choose Diversicare as an Assistant Director of Nursing (RN)?
Leadership Opportunity: As our Assistant Director of Nursing, you'll play a pivotal role in shaping the quality of care and the future of our nursing department. Lead by example, inspire your team, and make a lasting impact on patient outcomes.
Career Growth: At Diversicare, we're committed to your professional development. With access to ongoing training, mentorship programs, and advancement opportunities, you'll have the support you need to advance your nursing career.
Supportive Team Environment: Join a team of dedicated healthcare professionals who share your passion for providing exceptional care. Experience a collaborative work environment where your contributions are valued, and your leadership is recognized.
Comprehensive Benefits: Enjoy a competitive benefits package that includes competitive salary, medical, dental, and vision insurance, a 401(k) retirement plan, tuition reimbursement, paid time off, and more. We believe in investing in our employees' well-being so they can thrive both personally and professionally.
As our Assistant Director of Nursing, you'll have the opportunity to:
Lead and inspire our nursing team to ensure the highest standards of patient care and regulatory compliance.
Oversee staffing and training initiatives to foster a supportive and skilled nursing workforce.
Drive quality improvement initiatives to enhance patient outcomes and satisfaction.
Play a key role in achieving our mission of providing exceptional care to our patients and residents.
Qualifications:
Current RN license issued by the State Board of Nursing
Minimum of three years of nursing experience, with at least one year of supervisory experience
Strong leadership abilities, excellent communication skills, and a commitment to quality care
Experience in long-term care or skilled nursing facilities preferred
PCO Medical Director- UM - Full Time
Medical director job in Jackson, MS
**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 - Nat'l UM Team 1wknd/mo
Medical director job in Jackson, MS
**Become a part of our caring community and help us put health first** Become a part of our caring community and help us put health first The Medical Director actively uses their medical background, experience, and judgement to make determinations whether requested services, level of care, and/or site of service should be authorized. All work occurs within 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 reference sources. Medical Directors will learn Medicare and Medicare Advantage requirements and will understand how to operationalize this knowledge in their daily work.
Weekend work required one weekend per month with compensated days off during the work week
The Medical Director's work includes reviewing of all submitted medical records, synthesizing complex hospital-based clinical scenarios, and providing expert decisioning on the requested services. They will have regular discussions with external providers by phone to gather additional clinical information and discuss determinations. Medical directors are expected to understand Humana processes with a focus on collaborative professional relationships. The ideal candidate will have a high degree of integrity, professionalism, resourcefulness, and enjoy working in a team-based environment. Medical Directors support Humana value throughout all activities.
**Responsibilities**
The Medical Director provides medical interpretation and determinations whether services provided by other healthcare professionals are concordant with national guidelines, CMS requirements, Humana policies, clinical standards, and (in some cases) contracts. After completion of structured and mentored training, daily work is performed with minimal direction, but with ready support from other team members. The ideal candidate enjoys working in a structured environment with expectations for consistency in thinking and authorship. Exercises independence in meeting departmental expectations and meets compliance timelines.
+ Conduct comprehensive, timely, and compliant medical necessity reviews for inpatient services
+ Maintain accountability for productivity, quality, and compliance metrics
+ Communicate determinations clearly both verbally and in writing
+ Demonstrate adaptability and willingness to learn evolving workflows, tools, and utilization management practices
+ **Weekend work required one weekend per month with compensated days off during the work week**
**Use your skills to make an impact**
**Use your skills to make an impact**
**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 an approved ABMS Medical Specialty
+ A current and unrestricted license in at least one jurisdiction and willing to obtain additional license, if required.
+ No current sanction from Federal or State Governmental organizations, and able to pass credentialing requirements.
+ Excellent verbal and written communication skills.
+ Evidence of analytic and interpretation skills, with prior experience working in a team environment
**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, or other healthcare providers.
+ Utilization management 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
+ Experience in hospital-based clinical practice, including specialties of Internal Medicine, Family Practice, Geriatrics, Hospitalist, Emergency Medicine, and hospital-based clinical specialists
+ The curiosity to learn and the flexibility to adapt to changes in order to enhance efficiency, productivity, and organizational goals.
+ Ability to thrive in a dynamic fast-paced, team-oriented environment.
+ Commitment to a culture of innovation, including being facile with using technology to improve workflows
+ Participate in educational activities by attending required conferences and also create content to lead/teach/present for individual subject matter contribution
+ Passionate about contributing to an organization's focus on consistency in outcomes, consumer experiences and a highly engaged team culture
**Additional Information**
The medical director reports to a Lead Medical Director.
Participation in weekend work on a rotational basis to ensure cases are decisioned in a timely manner
May participate on project teams or organizational committees.
\#physiciancareers
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: 04-30-2026
**About us**
Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.
**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.
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 ***************************************************************************
Medical Director
Medical director job in Jackson, MS
This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and most current clinical standards. The incumbent reviews escalated cases electronically and using Medical Policy criteria sets to evaluate the medical necessity and appropriateness of the requested treatment of service. Depending on the nature of the case, telephonic peer to peer discussions may be required. The incumbent ensures compliance to NCQA, URAC, CMS, DOH, and DOL regulations at all times. In addition to utilization review, the incumbent participates as the physician member of the multidisciplinary team for case and disease management. They will advise the multidisciplinary team on cases, particularly high-risk cases, through the team structure. Additionally, the incumbent may be assigned special projects to help support and improve the care of our members
**ESSENTIAL RESPONSIBILITIES**
+ Conduct electronic review of escalated cases against medical policy criteria, which may include telephonic peer to peer discussions, to determine medical necessity and appropriateness. Complete initial determination of cases, review of appeals and grievances, and other reviews as assigned. Compose clear and concise rationales for member and provider determination notifications all while adhering to required compliance standards (NCQA, URAC, CMS, DOH, and DOL regulations, etc.). Ensure that all aspects of the medical management process are consistent with community standards of care.
+ Participate as a member of the CMDM multidisciplinary team. Attend huddles and grand rounds. Advise multidisciplinary team on cases that require physician expertise.
+ Participate in protocol and guidelines development to ensure consistency in the review process.
+ Actively manage projects and/or participate on project teams that require a physician subject matter expert.
+ Other duties as assigned.
**EDUCATION**
**Required**
+ Medical Doctor (MD) or Doctor of Osteopathic Medicine (DO)
**Substitutions**
+ None
**Preferred**
+ Master's Degree in Business Administration/Management or Public Health
**EXPERIENCE**
**Required**
+ 5 years in Clinical, Direct Patient care (hospital, outpatient, or private practice)
**Preferred**
+ 1 year in Medical Management in a Health Insurance Plan; strong knowledge of managed care industry
**LICENSES AND CERTIFICATION**
**Required**
+ Medical Doctor or Doctor of Osteopathic Medicine (DO)
+ Awarded Board Certification at least once in specialty recognized by the American Board of Medical Specialties or the American Osteopathic Association Specialty Certifying Boards
+ Active medical state licensure required. Additional specific state licensure(s) may be required based on business need.
**Preferred**
+ None
**SKILLS**
+ Critical Thinking
+ Case Management
+ Customer Service
+ Oral & Written Communication Skills
+ Collaboration
+ Listening
+ Telephone Skills
+ General Computer Skills
+ Clinical Software
+ Managed Care
**Language (Other than English)**
None
**Travel Required**
0% - 25%
**PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS**
Position Type
Office-Based
Teaches / trains others regularly
Occasionally
Travel regularly from the office to various work sites or from site-to-site
Rarely
Works primarily out-of-the office selling products/services (sales employees)
Never
Physical work site required
No
Lifting: up to 10 pounds
Constantly
Lifting: 10 to 25 pounds
Rarely
Lifting: 25 to 50 pounds
Rarely
**_Disclaimer:_** _The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job._
**_Compliance Requirement_** _: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies._
_As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company's Handbook of Privacy Policies and Practices and Information Security Policy._
_Furthermore, it is every employee's responsibility to comply with the company's Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements._
**Pay Range Minimum:**
$170,000.00
**Pay Range Maximum:**
$352,500.00
_Base pay is determined by a variety of factors including a candidate's qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets._
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.
We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below.
For accommodation requests, please contact HR Services Online at *****************************
California Consumer Privacy Act Employees, Contractors, and Applicants Notice
Req ID: J266916
Medical Director - Ophthalmology
Medical director job in Jackson, MS
**Parexel** is in the business of improving the world's health. We do this by providing a suite of biopharmaceutical services that help clients across the globe transform scientific discoveries into new treatments. From clinical trials to regulatory, consulting, and market access, our therapeutic, technical, and functional ability is underpinned by a deep conviction in what we do. We believe in our values, Patients First, Quality, Respect, Empowerment & Accountability.
**Parexel is looking for a Medical Director with a very strong background in Ophthalmology to join our Global Medical Sciences team.**
**The role can be based remo** t **ely in the US or Canada.**
The Medical Director is a medical expert with specialized therapeutic expertise and some experience across indications, clients and drug development. They initiate and maintain medical and consultative relationships with clients, consult on early engagement and pre-award efforts and serve as a medical monitor for contracted projects. The Medical Director may take on leadership roles by participating in initiatives, mentoring junior MDs and/or, where appropriate, managing a team of physicians.
Primary activities will focus on **Medical Monitoring Delivery & PV Support** . The medical monitor will independently deliver all medical support required for successful delivery of the projects according to contracted agreement with the sponsor (i.e., tasks and time per task contracted) and according to the assigned role (Global Lead Physician or Regional Lead Physician).
**Medical Expertise** and experience in **Ophthalmology** is essential to the medical monitor role and will be manifested in high quality consultation on protocol development or drug development programs, medical review of various documents, collaboration on internal therapeutic area meetings, training module development, white papers, slide sets, publications etc.
**Client Relationship Building & Engagement,** including soliciting and addressing client feedback and suggestions regarding medical study-related activities, are core skills required of the medical monitor.
**Business Development:** the medical monitor will provide medical expertise / leadership in Proposal Development Teams (PDTs) for client bid pursuit meetings.
**Skills**
+ Excellent interpersonal skills including the ability to interact well with sponsor/client counterparts
+ Client-focused approach to work
+ Excellent time management skills
+ Excellent verbal and written medical communication skills
+ Excellent standard of written and spoken English
+ A flexible attitude with respect to work assignments and new learning
+ Ability to manage multiple and varied tasks with enthusiasm and prioritize workload with attention to detail
+ Willingness to work in a matrix environment and to value the importance of teamwork.
**Knowledge And Experience**
+ Experience in clinical medicine (general or specialist qualifications) with Fellowship or specialty training in **Ophthalmology** , which is expected to be kept up to date.
+ A background in clinical aspects of drug development, including all aspects of Medical Monitoring and study design/execution, preferred
+ Clinical practice experience
+ Good knowledge of the drug development process including drug safety, preferred
+ Experience in Pharmaceutical Medicine, preferred
+ Experience leading, mentoring and managing individuals/ a team, preferred
**Education**
+ US Board certified in **Ophthalmology** or Canadian equivalent
+ Experience as a Physician in Industry or as a clinical trial investigator is required
+ Previous CRO experience is strongly preferred
+ Medically qualified in an acknowledged medical school with completion of at least basic training in clinical medicine (residency, internship)
The ability to travel 15% domestically or internationally is required
\#LI-LB1
\#LI-REMOTE
EEO Disclaimer
Parexel is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to legally protected status, which in the US includes race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.
Field Medical Director, Oncology
Medical director job in Jackson, MS
**Your Future Evolves Here** Evolent partners with health plans and providers to achieve better outcomes for people with most complex and costly health conditions. Working across specialties and primary care, we seek to connect the pieces of fragmented health care system and ensure people get the same level of care and compassion we would want for our loved ones.
Evolent employees enjoy work/life balance, the flexibility to suit their work to their lives, and autonomy they need to get things done. We believe that people do their best work when they're supported to live their best lives, and when they feel welcome to bring their whole selves to work. That's one reason why diversity and inclusion are core to our business.
Join Evolent for the mission. Stay for the culture.
**What You'll Be Doing:**
As a Field Medical Director, Oncology, you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in patients lives, in a non-clinical environment. You can enjoy better work- life balance on a team that values collaboration and continuous learning while providing better health outcomes.
**Collaboration Opportunities:**
· Routinely interacts with leadership and management staff, other Physicians, and staff whenever a physician`s input is needed or required.
**What You Will Be Doing:**
· Serve as the Physician match reviewer in Advanced Imaging cases, that do not initially meet the applicable medical necessity guidelines, as well as other imaging requests when providers, clients, or state laws require specialty reviews to be completed by the subject matter expert.
· Discusses determinations (peer to peer phone calls) with requesting physicians or ordering providers, when available, within the regulatory timeframe of the request and provides clinical rationale for standard and expedited appeals.
· Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD review process to reflect appropriate utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance (NCQA) guidelines.
· Aids and acts as a resource to Initial Clinical Reviewers.
· Ensures documentation of all communications with medical office staff and/or MD provider is recorded in a timely and accurate manner.
· May assist the Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support.
· Participates in on-going training per inter-rater reliability process.
**Qualifications:**
· MD/DO/MBBS
· Minimum of five (5) years' experience in the practice of Medicine, post residency and Active Clinical practice within the last 2 years is preferred
· Current, unrestricted clinical license in medicine or required specialty
· Obtaining and maintaining medical licenses in the state you reside, as well as, any license required per business needs
· Active Board Certification in Adult Medical Oncology
· Strong clinical, management, communication, and organizational skills
· Energetic and curious with a passion for quality and value in health car
· Computer Proficiency
· Not under current exclusion or sanction by any state or federal health care program, including Medicare or Medicaid, and is not identified as an "excluded person" by the Office of Inspector General of the Department of Health and Human Services or the General Service Administration (GSA), or reprimanded or sanctioned by Medicare.
· No history of disciplinary or legal action by a state medical board
To ensure a secure hiring process we have implemented several identity verification steps, including submission of a government issued photo ID. We conduct identity verification during interviews, and final interviews may require onsite attendance. All candidates must complete a comprehensive background check, in-person I-9 verification, and may be subject to drug screening prior to employment. The use of artificial intelligence tools during interviews is prohibited and monitored. Misrepresentation will result in immediate disqualification from consideration.
**Technical Requirements:**
We require that all employees have the following technical capability at their home: High speed internet over 10 Mbps and, specifically for all call center employees, the ability to plug in directly to the home internet router. These at-home technical requirements are subject to change with any scheduled re-opening of our office locations.
**Evolent is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, or disability status.** **If you need reasonable accommodation to access the information provided on this website, please contact** ************************** **for further assistance.**
The expected base salary/wage range for this position is $110-$125. This position is also eligible for a bonus component that would be dependent on pre-defined performance factors. As part of our total compensation package, Evolent is proud to offer comprehensive benefits (including health insurance benefits) to qualifying employees. All compensation determinations are based on the skills and experience required for the position and commensurate with experience of selected individuals, which may vary above and below the stated amounts.
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Associate Director, Medical Omnichannel Data Scientist
Medical director job in Jackson, MS
**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.
Medical Consultant- Psychiatrist
Medical director job in Jackson, MS
When you join the team at Unum, you become part of an organization committed to helping you thrive. Here, we work to provide the employee benefits and service solutions that enable employees at our client companies to thrive throughout life's moments. And this starts with ensuring that every one of our team members enjoys opportunities to succeed both professionally and personally. To enable this, we provide:
+ Award-winning culture
+ Inclusion and diversity as a priority
+ Performance Based Incentive Plans
+ Competitive benefits package that includes: Health, Vision, Dental, Short & Long-Term Disability
+ Generous PTO (including paid time to volunteer!)
+ Up to 9.5% 401(k) employer contribution
+ Mental health support
+ Career advancement opportunities
+ Student loan repayment options
+ Tuition reimbursement
+ Flexible work environments
**_*All the benefits listed above are subject to the terms of their individual Plans_** **.**
And that's just the beginning...
With 10,000 employees helping more than 39 million people worldwide, every role at Unum is meaningful and impacts the lives of our customers. Whether you're directly supporting a growing family, or developing online tools to help navigate a difficult loss, customers are counting on the combined talents of our entire team. Help us help others, and join Team Unum today!
**General Summary:**
This position is responsible for providing expert medical analysis of claims files (or underwriting applications) across Unum US product lines. The incumbent provides high quality, timely, and efficient medical consultative services to the Benefits Center. The Medical Consultant adheres to current regulatory, claim process, and internal workflow standards as set forth in the Benefits Center Claims Manual, underwriting manual, and associated documentation. The incumbent adheres to accepted norms of medical practices and Code of Conduct guidelines. Physicians and psychologists conduct their reviews and analyses within appropriate ethical standards and maintain their professional licenses and Board certifications. This role is expected to provide excellent customer service and to interact on a regular basis with business partners, health care providers, and other specialized resources.
**Principal Duties and Responsibilities**
+ Provide timely, clear medical direction and opinions to team partners, with reasoned forensic analysis to support the medical opinions
+ Partner/consult with fellow medical consultants when appropriate to ensure the completion of a whole person analysis
+ Apply medical knowledge to determine functional capacity through assessment of medical and other data related to impairment, regarding accuracy of diagnoses, treatment plans, duration guidelines, and prognosis
+ Provide relevant medical education and knowledge to others in terms appropriate and understandable to the intended audience
+ Perform telephone contacts with the insured's healthcare providers to gather medical information and to facilitate a better understanding of the claimant's functional abilities
+ Make timely and appropriate referrals for second opinion reviews when appropriate or required according to current guidelines and best practices
+ Demonstrate ability to manage and complete high volumes of assigned work, maintain consistently good turnaround times, and operate with a sense of urgency
+ Focus not only on individual workload, but on the team/group work volumes to ensure organizational success
+ Receive feedback and follow through with appropriate behaviors/actions
+ Perform other duties as assigned
**Job Specifications**
+ Professional Degree (MD, DO, PhD, PsyD)
+ Active, unrestricted US medical license
+ Board certification required for physicians in their area of specialty
+ Minimum of five years of clinical experience in medical specialty
+ Strong team and collaborative skills. Ability to work in a fast paced, team based, corporate environment
+ Ability to mentor others and to give and receive constructive, behaviorally based feedback with peers and partners
\#IN1
\#LI-RA1
Unum and Colonial Life are part of Unum Group, a Fortune 500 company and leading provider of employee benefits to companies worldwide. Headquartered in Chattanooga, TN, with international offices in Ireland, Poland and the UK, Unum also has significant operations in Portland, ME, and Baton Rouge, LA - plus over 35 US field offices. Colonial Life is headquartered in Columbia, SC, with over 40 field offices nationwide.
Unum is an equal opportunity employer, considering all qualified applicants and employees for hiring, placement, and advancement, without regard to a person's race, color, religion, national origin, age, genetic information, military status, gender, sexual orientation, gender identity or expression, disability, or protected veteran status.
The base salary range for applicants for this position is listed below. Unless actual salary is indicated above in the job description, actual pay will be based on skill, geographical location and experience.
$133,500.00-$274,100.00
Additionally, Unum offers a portfolio of benefits and rewards that are competitive and comprehensive including healthcare benefits (health, vision, dental), insurance benefits (short & long-term disability), performance-based incentive plans, paid time off, and a 401(k) retirement plan with an employer match up to 5% and an additional 4.5% contribution whether you contribute to the plan or not. All benefits are subject to the terms and conditions of individual Plans.
Company:
Unum
Manager, Medical Rebates Execution
Medical director job in Jackson, MS
**_What Finance Operations contributes to Cardinal Health_** Finance oversees the accounting, tax, financial plans and policies of the organization, establishes and maintains fiscal controls, prepares and interprets financial reports, oversees financial systems and safeguards the organization's assets.
Finance Operations is responsible for core financial operation processes. This can include customer and vendor contract administration; customer and vendor pricing, rebates, billing vendor chargeback research and reconciliation; processing vendor invoices and employee expense reports for payment; fixed asset accounting for book and tax records; cash application; and journal entries.
+ Demonstrates knowledge of financial processes, accounting policies, systems, controls, and work streams
+ Demonstrates experience working in a transnational finance environment coupled with strong internal controls
+ Possesses understanding of service level goals and objectives when providing customer support
+ Works collaboratively to respond to non-standard requests
+ Possesses strong organizational skills and prioritizes getting the right things done
**_Responsibilities_**
+ Manage a team of Cardinal Health and Genpact individuals who oversee the entirety of the GPO Admin Fees and Rebates set up and report creation functions, including P&L accruals, rebate setups within SAP Vistex and ad hoc reporting for key internal and external stakeholders
+ Ensure GPO Admin Fees and Rebates are properly accounted for
+ Own first level review/approval responsibilities for non-standard rebate structures to ensure proper audit documentation is maintained and proper approvals are received
+ Oversee key rebate accuracy and timeliness CSLs and KPIs
+ Partner with cross-functional teams to research and resolve root cause issues impacting rebate accuracy or ability to set up Rebates and GPO Admin Fees timely; apply big picture knowledge to assess and interpret financial impact of process changes and resulting driver outcomes of GPO Admin Fee/Rebate set up changes
+ Foster a strong SOX internal control structure and seek opportunities for improvements, including build out of SOP processes and project development
+ Transform current payout and reporting process into Vistex implementation and go-forward build/upkeep
+ Develop plans for future systematic enhancements
+ Assist team with more complicated customer and transaction activities; oversee escalations to ensure closure in a timely manner
+ Partner with and be a thought-provoking leader to business partners across the organization to properly account for transactions, including but not limited to Sales, Legal, Finance, Pricing, Accounting and Contracting
+ Actively collaborate and support cross-functional team initiatives to improve customer experience, both internally and externally
+ Establish team and individual-oriented goals for growth and development
**_Qualifications_**
+ Bachelor's Degree in Accounting, Finance or Business Management, preferred
+ 8+ years of professional experience in related field preferred, including but not limited to Accounting, Finance, or Audit
+ Accounting and Finance acumen
+ Ability to lead a new team and influence others
+ Knowledge with SAP and legal contracts (revenue recognition standards is a plus)
+ Data mining experience (relevant application tool experience is a plus)
+ Strong written and verbal communication skills
+ Process improvement oriented
+ Strong SOX/internal control understanding
**_What is expected of you and others at this level_**
+ Applies comprehensive knowledge and a thorough understanding of concepts, principles, and technical capabilities to manage varied tasks and projects
+ Manages department operations, supervises professional employees, and ensures employees operate within guidelines
+ Develop team and individual development plan goals for direct reports
+ Participates in the development of policies and procedures to achieve specific goals
+ Recommends new practices, processes, metrics, or models
+ Works on or may lead complex projects of large scope, including leading offshore teams and working in conjunction with other CAH teams
+ Develops technical solutions to a wide range of difficult problems; solutions are innovative and consistent with organization objectives
+ Receives guidance on overall project objectives
+ Independently determines method for completion of new projects
+ Gains consensus from various parties involved
+ Acts as a mentor to less experienced colleagues
**Anticipated salary range:** $105,100 - $135,090
**Bonus eligible:** Yes
**Benefits:** Cardinal Health offers a wide variety of benefits and programs to support health and well-being.
+ Medical, dental and vision coverage
+ Paid time off plan
+ Health savings account (HSA)
+ 401k savings plan
+ Access to wages before pay day with my FlexPay
+ Flexible spending accounts (FSAs)
+ Short- and long-term disability coverage
+ Work-Life resources
+ Paid parental leave
+ Healthy lifestyle programs
**Application window anticipated to close:** 12/28/2025 *if interested in opportunity, please submit application as soon as possible.
The salary range listed is an estimate. Pay at Cardinal Health is determined by multiple factors including, but not limited to, a candidate's geographical location, relevant education, experience and skills and an evaluation of internal pay equity.
_Candidates who are back-to-work, people with disabilities, without a college degree, and Veterans are encouraged to apply._
_Cardinal Health supports an inclusive workplace that values diversity of thought, experience and background. We celebrate the power of our differences to create better solutions for our customers by ensuring employees can be their authentic selves each day. Cardinal Health is an Equal_ _Opportunity/Affirmative_ _Action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, ancestry, age, physical or mental disability, sex, sexual orientation, gender identity/expression, pregnancy, veteran status, marital status, creed, status with regard to public assistance, genetic status or any other status protected by federal, state or local law._
_To read and review this privacy notice click_ here (***************************************************************************************************************************
Director Nursing 4 - Emergency Department
Medical director job in Jackson, MS
Supervises and coordinates patient care services of one or more nursing units on a 24-hour basis. The Dir, Nursing ensures that physicians' orders are followed; ensures that patient conditions and progress are accurately reported; ensures that patient care is administered by all professional and nonprofessional personnel in the unit according to organization and regulatory policies and guidelines; and has staffing and budget control responsibilities for the unit.
Education - Bachelors of Science in Nursing from an accredited school of nursing
Licensure: Current licensure in good standing in the state of Mississippi; Current BLS required. ACLS preferred.
1. Leadership
a. Utilizes advanced clinical knowledge to develop and maintain a delivery system for individualized, appropriate, and compassionate patient care. Supports and encourages staff, patients, and significant others in the determination of treatment and rehabilitation goals for desired outcomes. Provides leadership and participates in emergency measures for sudden adverse patient developments.
b. Provides leadership and demonstrates critical thinking ability in all areas of responsibility, treats all co-workers with respect, strives to enhance co-worker performance through cooperation and effective communication, and demonstrates hospitality and courtesy in all interactions.
2. Unit Management and Daily Operations
a. Estimates future departmental personnel, equipment, and supply needs in order to ensure the attainment of operating goals. Develops, recommends, and implements the annual capital equipment, personnel, and operating budget for the department. Conducts periodic reviews of departmental performance, analyzes budget variances, and implements responsive action.
b. Demonstrates clinical expertise in facilitating the timely availability, access, and utilization of multidisciplinary health care services, alternative levels of care, and community resources in a manner that ensures optimal continuity and expediency in the health care delivery process.
c. Implements strategies that use current scientific knowledge to prevent and reduce the risk of infection transmission. Promptly and appropriately reports infections between and among staff, patients, and visitors in order to improve patient outcomes.
d. Consults with nursing management, nursing staff, and Clinical Nurse Specialists in the development of instructional materials for patients and family members which will provide the specific knowledge and skill required to increase their understanding of the patient's illness, meet the patient's ongoing health care needs, and improve patient health outcomes.
e. Develops and maintains documentation required for successful employee development and administrative and divisional communication. Supervises and participates in the efficient recording of pertinent patient care data utilizing the computerized medical record and manual documentation in order to promote timely and efficient access to required information throughout the organization. Preserves the confidentiality of data and information identified as sensitive in order to ensure the protection of patient dignity and privacy.
f. Monitors and coordinates the effective use, maintenance, and repair of equipment, supplies, facilities, and resources that support patient care in order to maintain a functional and safe environment for patients, staff, and visitors.
g. Maintains own clinical expertise and ensures the demonstrated clinical competency of staff members to deliver patient care services in accordance with the specific identified needs of adult and geriatric patients. Utilizes appropriate resources as needed for assistance in the planning and delivery of care to infant, pediatric, and adolescent patients.
3. Performance Improvement and Quality
a. Provides ongoing assessments of the patient care delivery system in order to identify existing and potential health care needs within the scope of care for the unit. Evaluates and makes recommendations for current and potential unit staffing needs, assesses and introduces technological and procedural changes that enhance the efficiency and quality of patient care services and outcomes, and supervises the ongoing assessment of patients for physical, psychological, and social status needs and discharge planning.
b. Coordinates and manages high quality health care services that recognize individual patient rights while acting as a role model for the nursing personnel. Educates staff and monitors care delivery in order to ensure that patients exercise their rights to be informed and to participate and make decisions in all aspects of their medical care. Ensures that patient care demonstrates respect for personal values and beliefs and is focused on the unique needs of each individual and their family.
c. Utilizes continued analysis and evaluation of patient care outcomes to enhance the quality and efficiency of services and optimize the utilization of hospital resources. Participates actively in unit-specific and multidisciplinary continuous quality improvement and quality assurance studies in a manner that promotes compliance with hospital and divisional regulations and standards.
d. Ensures that all staff members are oriented and continuously educated regarding their roles in sustaining and improving the overall environment. Assesses the learning and development needs of staff members and is responsible for the provision of appropriate educational services.
e. Establishes departmental standards for the evaluation of personnel performance and monitors the performance of reporting personnel. Promotes and encourages the growth and development of staff members by encouraging their participation in approved continuing education activities such as professional conferences, seminars, and workshops. Advocates continuing education as a means of promoting the high quality services provided by all departmental personnel.
f. Observes and adheres to all departmental and hospital policies and procedures, and follows all safety, quality assurance, and infection control standards.
4. Other Duties As Assigned
a. Performs other duties as assigned or requested.
Auto-ApplyDirector Nursing 4 - Emergency Department
Medical director job in Jackson, MS
Supervises and coordinates patient care services of one or more nursing units on a 24-hour basis. The Dir, Nursing ensures that physicians' orders are followed; ensures that patient conditions and progress are accurately reported; ensures that patient care is administered by all professional and nonprofessional personnel in the unit according to organization and regulatory policies and guidelines; and has staffing and budget control responsibilities for the unit.
Education - Bachelors of Science in Nursing from an accredited school of nursing
Licensure: Current licensure in good standing in the state of Mississippi; Current BLS required. ACLS preferred.
1. Leadership
a. Utilizes advanced clinical knowledge to develop and maintain a delivery system for individualized, appropriate, and compassionate patient care. Supports and encourages staff, patients, and significant others in the determination of treatment and rehabilitation goals for desired outcomes. Provides leadership and participates in emergency measures for sudden adverse patient developments.
b. Provides leadership and demonstrates critical thinking ability in all areas of responsibility, treats all co-workers with respect, strives to enhance co-worker performance through cooperation and effective communication, and demonstrates hospitality and courtesy in all interactions.
2. Unit Management and Daily Operations
a. Estimates future departmental personnel, equipment, and supply needs in order to ensure the attainment of operating goals. Develops, recommends, and implements the annual capital equipment, personnel, and operating budget for the department. Conducts periodic reviews of departmental performance, analyzes budget variances, and implements responsive action.
b. Demonstrates clinical expertise in facilitating the timely availability, access, and utilization of multidisciplinary health care services, alternative levels of care, and community resources in a manner that ensures optimal continuity and expediency in the health care delivery process.
c. Implements strategies that use current scientific knowledge to prevent and reduce the risk of infection transmission. Promptly and appropriately reports infections between and among staff, patients, and visitors in order to improve patient outcomes.
d. Consults with nursing management, nursing staff, and Clinical Nurse Specialists in the development of instructional materials for patients and family members which will provide the specific knowledge and skill required to increase their understanding of the patient's illness, meet the patient's ongoing health care needs, and improve patient health outcomes.
e. Develops and maintains documentation required for successful employee development and administrative and divisional communication. Supervises and participates in the efficient recording of pertinent patient care data utilizing the computerized medical record and manual documentation in order to promote timely and efficient access to required information throughout the organization. Preserves the confidentiality of data and information identified as sensitive in order to ensure the protection of patient dignity and privacy.
f. Monitors and coordinates the effective use, maintenance, and repair of equipment, supplies, facilities, and resources that support patient care in order to maintain a functional and safe environment for patients, staff, and visitors.
g. Maintains own clinical expertise and ensures the demonstrated clinical competency of staff members to deliver patient care services in accordance with the specific identified needs of adult and geriatric patients. Utilizes appropriate resources as needed for assistance in the planning and delivery of care to infant, pediatric, and adolescent patients.
3. Performance Improvement and Quality
a. Provides ongoing assessments of the patient care delivery system in order to identify existing and potential health care needs within the scope of care for the unit. Evaluates and makes recommendations for current and potential unit staffing needs, assesses and introduces technological and procedural changes that enhance the efficiency and quality of patient care services and outcomes, and supervises the ongoing assessment of patients for physical, psychological, and social status needs and discharge planning.
b. Coordinates and manages high quality health care services that recognize individual patient rights while acting as a role model for the nursing personnel. Educates staff and monitors care delivery in order to ensure that patients exercise their rights to be informed and to participate and make decisions in all aspects of their medical care. Ensures that patient care demonstrates respect for personal values and beliefs and is focused on the unique needs of each individual and their family.
c. Utilizes continued analysis and evaluation of patient care outcomes to enhance the quality and efficiency of services and optimize the utilization of hospital resources. Participates actively in unit-specific and multidisciplinary continuous quality improvement and quality assurance studies in a manner that promotes compliance with hospital and divisional regulations and standards.
d. Ensures that all staff members are oriented and continuously educated regarding their roles in sustaining and improving the overall environment. Assesses the learning and development needs of staff members and is responsible for the provision of appropriate educational services.
e. Establishes departmental standards for the evaluation of personnel performance and monitors the performance of reporting personnel. Promotes and encourages the growth and development of staff members by encouraging their participation in approved continuing education activities such as professional conferences, seminars, and workshops. Advocates continuing education as a means of promoting the high quality services provided by all departmental personnel.
f. Observes and adheres to all departmental and hospital policies and procedures, and follows all safety, quality assurance, and infection control standards.
4. Other Duties As Assigned
a. Performs other duties as assigned or requested.
Auto-ApplyAssistant Director of Nursing
Medical director job in Pearl, MS
Advance Your Nursing Leadership Career as an Assistant Director of Nursing (RN) at Diversicare of Meridian in Meridian, MS!
Are you an experienced RN with a passion for leadership and a drive for excellence in healthcare? Diversicare, a leading provider of post-acute care services, invites you to take the next step in your nursing career as our Assistant Director of Nursing.
Why Choose Diversicare as an Assistant Director of Nursing (RN)?
Leadership Opportunity: As our Assistant Director of Nursing, you'll play a pivotal role in shaping the quality of care and the future of our nursing department. Lead by example, inspire your team, and make a lasting impact on patient outcomes.
Career Growth: At Diversicare, we're committed to your professional development. With access to ongoing training, mentorship programs, and advancement opportunities, you'll have the support you need to advance your nursing career.
Supportive Team Environment: Join a team of dedicated healthcare professionals who share your passion for providing exceptional care. Experience a collaborative work environment where your contributions are valued, and your leadership is recognized.
Comprehensive Benefits: Enjoy a competitive benefits package that includes competitive salary, medical, dental, and vision insurance, a 401(k) retirement plan, tuition reimbursement, paid time off, and more. We believe in investing in our employees' well-being so they can thrive both personally and professionally.
As our Assistant Director of Nursing, you'll have the opportunity to:
Lead and inspire our nursing team to ensure the highest standards of patient care and regulatory compliance.
Oversee staffing and training initiatives to foster a supportive and skilled nursing workforce.
Drive quality improvement initiatives to enhance patient outcomes and satisfaction.
Play a key role in achieving our mission of providing exceptional care to our patients and residents.
Qualifications:
Current RN license issued by the State Board of Nursing
Minimum of three years of nursing experience, with at least one year of supervisory experience
Strong leadership abilities, excellent communication skills, and a commitment to quality care
Experience in long-term care or skilled nursing facilities preferred
PCO Medical Director - UM - Part Time (Hourly)
Medical director job in Jackson, MS
**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 *************************************************************
OneHome - Medical Director - Part Time
Medical director job in Jackson, MS
**Become a part of our caring community and help us put health first** The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing home health, SNF, DME, dual Medicare/Medicaid and Waiver requests. 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 Medical Director provides medical interpretation and decisions about the appropriateness of services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards. 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 works in a structured environment with expectations for consistency in thinking, authorship, meeting departmental expectations, and compliance timelines.
**Use your skills to make an impact**
**Required Qualifications**
+ MD or DO degree
+ **Current and ongoing board certification through an approved ABMS or AOABPS Medical Specialty is a requirement. NBPAS certification is not accepted.**
+ **A current and unrestricted license in at least one jurisdiction and willing to obtain license, as required, for various states in region of assignment**
+ **5+ years of direct clinical patient care experience post residency or fellowship**
+ **No sanctions from Federal or State Governmental organizations**
+ **The ability to pass credentialing requirements**
+ **Excellent verbal and written communication skills with analytic and interpretative skills**
+ **Participate in educational activities by attending required conferences and also create content to lead/teach/present for individual subject matter contribution**
**Preferred Qualifications**
+ Experience in an inpatient environment and/or related to care of a Medicare type population (disabled or >65 years of age)
+ **Internal Medicine, Family Practice, Geriatrics, Physiatry, Emergency Medicine, Critical Care or hospital based clinical specialists**
+ **Ability to function in a dynamic fast paced environment**
+ **Commitment to a culture of innovation**
+ **Passionate about contributing to an organization's focus on consistency in outcomes, consumer experiences, and a highly engaged team culture**
+ **Knowledge and experience with national guidelines such as NCD/LCD, MCG or InterQual**
**The Medical Director conducts clinical case reviews of requests received by members of the Medicare population and reports to the Lead Medical Director.**
**Other duties:**
+ Identify medical management operational improvements, including those within the medical director area
+ **Participate in call rotation which includes weekend coverage**
+ **Develop collaborative relationships with Team and key partners within the Medicare Line of Business.**
+ **Support Home Solutions as needed**
+ **Other activities as assigned by the managing Medical Director**
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: 01-31-2026
**About us**
Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.
**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.
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 ***************************************************************************
Medical Director, Medical Management
Medical director job in Jackson, MS
This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and most current clinical standards. The incumbent reviews escalated cases electronically and using Medical Policy criteria sets to evaluate the medical necessity and appropriateness of the requested treatment of service. Depending on the nature of the case, telephonic peer to peer discussions may be required. The incumbent ensures compliance to NCQA, URAC, CMS, DOH, and DOL regulations at all times. In addition to utilization review, the incumbent participates as the physician member of the multidisciplinary team for case and disease management. They will advise the multidisciplinary team on cases, particularly high-risk cases, through the team structure. Additionally, the incumbent may be assigned special projects to help support and improve the care of our members
**ESSENTIAL RESPONSIBILITIES**
+ Conduct electronic review of escalated cases against medical policy criteria, which may include telephonic peer to peer discussions, to determine medical necessity and appropriateness. Complete initial determination of cases, review of appeals and grievances, and other reviews as assigned. Compose clear and concise rationales for member and provider determination notifications all while adhering to required compliance standards (NCQA, URAC, CMS, DOH, and DOL regulations, etc.). Ensure that all aspects of the medical management process are consistent with community standards of care.
+ Participate as a member of the CMDM multidisciplinary team. Attend huddles and grand rounds. Advise multidisciplinary team on cases that require physician expertise.
+ Participate in protocol and guidelines development to ensure consistency in the review process.
+ Actively manage projects and/or participate on project teams that require a physician subject matter expert.
+ Other duties as assigned.
**EDUCATION**
**Required**
+ Medical Doctor (MD) or Doctor of Osteopathic Medicine (DO)
**Substitutions**
+ None
**Preferred**
+ Master's Degree in Business Administration/Management or Public Health
**EXPERIENCE**
**Required**
+ 5 years in Clinical, Direct Patient care (hospital, outpatient, or private practice)
**Preferred**
+ 1 year in Medical Management in a Health Insurance Plan; strong knowledge of managed care industry
**LICENSES AND CERTIFICATION**
**Required**
+ Medical Doctor or Doctor of Osteopathic Medicine (DO)
+ Awarded Board Certification at least once in specialty recognized by the American Board of Medical Specialties or the American Osteopathic Association Specialty Certifying Boards
+ Active medical state licensure required. Additional specific state licensure(s) may be required based on business need.
**Preferred**
+ None
**SKILLS**
+ Critical Thinking
+ Case Management
+ Customer Service
+ Oral & Written Communication Skills
+ Collaboration
+ Listening
+ Telephone Skills
+ General Computer Skills
+ Clinical Software
+ Managed Care
**Language (Other than English)**
None
**Travel Required**
0% - 25%
**PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS**
Position Type
Office-Based
Teaches / trains others regularly
Occasionally
Travel regularly from the office to various work sites or from site-to-site
Rarely
Works primarily out-of-the office selling products/services (sales employees)
Never
Physical work site required
No
Lifting: up to 10 pounds
Constantly
Lifting: 10 to 25 pounds
Rarely
Lifting: 25 to 50 pounds
Rarely
**_Disclaimer:_** _The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job._
**_Compliance Requirement_** _: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies._
_As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company's Handbook of Privacy Policies and Practices and Information Security Policy._
_Furthermore, it is every employee's responsibility to comply with the company's Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements._
**Pay Range Minimum:**
$170,000.00
**Pay Range Maximum:**
$352,500.00
_Base pay is determined by a variety of factors including a candidate's qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets._
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.
We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below.
For accommodation requests, please contact HR Services Online at *****************************
California Consumer Privacy Act Employees, Contractors, and Applicants Notice
Req ID: J272807
Field Medical Director, Pain Management
Medical director job in Jackson, MS
**Your Future Evolves Here** Evolent partners with health plans and providers to achieve better outcomes for people with most complex and costly health conditions. Working across specialties and primary care, we seek to connect the pieces of fragmented health care system and ensure people get the same level of care and compassion we would want for our loved ones.
Evolent employees enjoy work/life balance, the flexibility to suit their work to their lives, and autonomy they need to get things done. We believe that people do their best work when they're supported to live their best lives, and when they feel welcome to bring their whole selves to work. That's one reason why diversity and inclusion are core to our business.
Join Evolent for the mission. Stay for the culture.
**What You'll Be Doing:**
As a Physician Clinical Reviewer, Interventional Pain Management, you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in patients' lives, in a non-clinical environment. You can enjoy better work- life balance on a team that values collaboration and continuous learning while providing better health outcomes.
**Collaboration Opportunities:**
+ Routinely interacts with leadership and management staff, other Physicians, and staff whenever a physician`s input is needed or required. Aids and acts as a resource to Initial Clinical Reviewers.
**What You Will Be Doing:**
+ Serve as the Physician Clinical Reviewer for Interventional Pain Management, reviewing cases that do not initially meet the applicable medical necessity guidelines, as well as other imaging requests when providers, clients, or state laws require specialty reviews to be completed by the subject matter expert.
+ Discusses determinations (peer to peer phone calls) with requesting physicians or ordering providers, when available, within the regulatory timeframe of the request.
+ Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD review process to reflect appropriate utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance (NCQA) guidelines.
+ Provides clinical rationale for standard and expedited appeals.
+ Ensures documentation of all communications with medical office staff and/or MD provider is recorded in a timely and accurate manner.
+ Participates in on-going training per inter-rater reliability process.
+ On a requested basis, may function as Medical Director for selecting health plans or regions, assuming overall accountability for utilization management while working in conjunction with the Senior Medical Director. May assist the Senior Medical Director in research activities/questions.
**Qualifications - Required and Preferred:**
+ MD/DO/MBBS- **Required**
+ Minimum of five (5) years' experience in the practice of Pain Medicine, post-residency- **Preferred**
+ Current, unrestricted clinical license in medicine or required specialty- **Required**
+ Obtaining and maintaining medical licenses in the state you reside and any required per business needs- **Required**
+ Active Board Certification in Pain Management or Active Board Certification in another specialty and clinical experience in Interventional Pain Management- **Required**
+ Strong clinical, management, communication, and organizational skills- **Required**
+ Energetic and curious with a passion for quality and value in health care- **Required**
+ Computer Proficiency- **Required**
To ensure a secure hiring process we have implemented several identity verification steps, including submission of a government issued photo ID. We conduct identity verification during interviews, and final interviews may require onsite attendance. All candidates must complete a comprehensive background check, in-person I-9 verification, and may be subject to drug screening prior to employment. The use of artificial intelligence tools during interviews is prohibited and monitored. Misrepresentation will result in immediate disqualification from consideration.
**Technical Requirements:**
We require that all employees have the following technical capability at their home: High speed internet over 10 Mbps and, specifically for all call center employees, the ability to plug in directly to the home internet router. These at-home technical requirements are subject to change with any scheduled re-opening of our office locations.
**Evolent is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, or disability status.** **If you need reasonable accommodation to access the information provided on this website, please contact** ************************** **for further assistance.**
The expected base salary/wage range for this position is $105-110/hr. This position is also eligible for a bonus component that would be dependent on pre-defined performance factors. As part of our total compensation package, Evolent is proud to offer comprehensive benefits (including health insurance benefits) to qualifying employees. All compensation determinations are based on the skills and experience required for the position and commensurate with experience of selected individuals, which may vary above and below the stated amounts.
Don't see the dream job you are looking for? Drop off your contact information and resume and we will reach out to you if we find the perfect fit!
Associate Director, Congress & Medical Education Strategy & Execution - Rare Disease
Medical director job in Jackson, MS
The Associate Director, Congress and Medical Education Strategy & Execution is responsible for executing and contributing to the global medical strategy and tactical implementation for congresses and medical education, and supporting Otsuka's non-promotional scientific communication initiatives across the diverse Rare Disease portfolio.
This role leads scientific engagement through impactful congress planning & execution educational programs, and evidence-based content that support Otsuka's mission to improve patient outcomes through deep scientific understanding and collaborative partnerships.
The Associate Director partners closely with global and regional cross-functional stakeholders - including Global Medical Affairs, Clinical Development, Global Integrated Evidence & Innovation (GIE&I) and Commercial, to ensure scientific alignment, operational excellence and consistency in Otsuka's external scientific exchange.
****
**Key Responsibilities Include:**
**Congress Strategy and Execution**
+ Manage execution and contribute to the development of comprehensive multi-year medical congress strategy for the relevant therapeutic area aligned with Otsuka's pipeline and product lifecycle stages (e.g., establishing and developing an emerging portfolio), including prioritization of key international and regional congresses, scientific communication objectives, symposia, booth presence, and internal/external engagement activities
+ Collaborate with Medical Strategy, Medical Communications, Field Medical and Medical Information to develop high-quality, scientifically rigorous presentation and materials; ensuring data dissemination plans are timely, consistent, and strategically aligned
+ Support scientific communication planning across global and regional teams to ensure consistent, data-driven communication objectives across congress activities
+ Partner with Medical Communications to coordinate Otsuka's scientific presence at congresses, including:
+ Abstract submissions and poster presentations
+ Oral presentations and late-breaking sessions
+ Sponsored symposia and educational sessions
+ Medical booth design and operations
+ Press activities and medical engagement
+ Support planning and execution of engagement with external experts and stakeholders (e.g. KOLs, Patient Advocacy Groups) before during and after congresses
+ Organize and facilitate investigator meetings and advisory boards in conjunction with congress
+ Coordinate opportunities for scientific exchange between Otsuka Medical Affairs personnel and external experts and stakeholders
+ Manage end-to-end aspects of congress planning activities and post-congress insight generation to maximize impact and inform future strategies
+ Implement innovative digital strategies to extend congress reach and engagement, including virtual and hybrid congress solutions
+ Establish KPIs for congress activities and implement systems to track and analyze performance
+ Conduct post-congress analysis toa assess impact and identify areas for improvement
**Independent Medical Education (IME)**
+ Develop and implement the global medical education strategy for relevant therapeutic area in alignment with medical and objectives and strategy
+ Oversee the development of scientific exchange platforms, independent medical education (IME) initiatives to elevate disease and product knowledge globally
+ Partner with regional and local teams to ensure educational programs address unmet needs and comply with regional regulations and global standards
+ Identify, evaluate, and partner with external experts, medical societies and educational providers to ensure high-quality, unbiased scientific content delivery
+ Monitor educational impact through KPIs, metrics and insights
**Cross-Functional Collaboration**
+ Act as a key contributor and subject matter expert for the relevant therapeutic area medical education and congress activities
+ Collaborate with Medical Affairs, Clinical Development, Global Integrated Evidence & Innovation (GIE&I), Regulatory, and Commercial teams to ensure scientific alignment and appropriate integration of new evidence into educational content
+ Provide guidance and mentorship to team members and vendors to ensure high standards of scientific integrity, external experts and stakeholder (e.g., KOL) experience and operational excellence
+ Create and manage congress budgets, ensuring cost-effectiveness and ROI and ensure compliant use of medical education and congress funding
+ Represent Global Medical Affairs in governance forums and cross-functional planning meetings
+ Ensure all congress and medical education activities comply with global and local regulatory requirements, Otsuka policies, data publication embargos and industry codes
+ Proactively identify and mitigate risks related to scientific exchange and external engagements based on Global Medical Affairs policies and SOPs
+ Consider technology and AI to support workflow improvement
**Qualifications**
**Education and Experience:**
+ Advanced scientific or medical degree (PharmD, PhD, MD, or equivalent) preferred
+ Extensive experience working within relevant therapeutic area, including engagement with specialized HCPs and evidence generation strategies
+ Additional business or communications training (MBA, MPH, etc.) preferred
+ 12+ years of experience in Medical Affairs; ~5 years focused on congress strategy and execution is preferred
+ Proven success managing matrixed & cross-functional global teams and external vendors
+ Demonstrated experience leading global congress strategy, IME programs, or scientific engagement
+ Proven track record of successful congress planning and implementation on a global scale including implementation of digital and virtual congress solutions
+ In-depth understanding of industry compliance, regulatory frameworks, and ethical considerations for scientific engagement
**Skills and Competencies:**
+ Strategic and analytical thinker with the ability to translate complex science for a variety of audiences and anticipate trends and shape proactive congress and educational strategies
+ Excellent project management, communication (written and verbal), and stakeholder engagement skills
+ Collaborative and communicative, with ability excel at building and maintaining relationships with external stakeholders and experts (e.g. KOLs, scientific)
+ Financial acumen and experience managing large program budget
+ Ability to influence across matrixed teams and drive strategic initiatives
**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.
Assistant Director of Nursing
Medical director job in Madison, MS
Advance Your Nursing Leadership Career as an Assistant Director of Nursing (RN) at Diversicare of Quitman in Quitman, MS!
Are you an experienced RN with a passion for leadership and a drive for excellence in healthcare? Diversicare, a leading provider of post-acute care services, invites you to take the next step in your nursing career as our Assistant Director of Nursing.
Why Choose Diversicare as an Assistant Director of Nursing (RN)?
Leadership Opportunity: As our Assistant Director of Nursing, you'll play a pivotal role in shaping the quality of care and the future of our nursing department. Lead by example, inspire your team, and make a lasting impact on patient outcomes.
Career Growth: At Diversicare, we're committed to your professional development. With access to ongoing training, mentorship programs, and advancement opportunities, you'll have the support you need to advance your nursing career.
Supportive Team Environment: Join a team of dedicated healthcare professionals who share your passion for providing exceptional care. Experience a collaborative work environment where your contributions are valued, and your leadership is recognized.
Comprehensive Benefits: Enjoy a competitive benefits package that includes competitive salary, medical, dental, and vision insurance, a 401(k) retirement plan, tuition reimbursement, paid time off, and more. We believe in investing in our employees' well-being so they can thrive both personally and professionally.
As our Assistant Director of Nursing, you'll have the opportunity to:
Lead and inspire our nursing team to ensure the highest standards of patient care and regulatory compliance.
Oversee staffing and training initiatives to foster a supportive and skilled nursing workforce.
Drive quality improvement initiatives to enhance patient outcomes and satisfaction.
Play a key role in achieving our mission of providing exceptional care to our patients and residents.
Qualifications:
Current RN license issued by the State Board of Nursing
Minimum of three years of nursing experience, with at least one year of supervisory experience
Strong leadership abilities, excellent communication skills, and a commitment to quality care
Experience in long-term care or skilled nursing facilities preferred
Manager, Medical Core Content - Rare Disease
Medical director job in Jackson, MS
The Manager, Medical Core Content is a team-level operational role responsible for the development, maintenance, and day-to-day quality assurance of all core scientific and medical content for the relevant therapeutic area. This role focuses on the execution and production of scientific assets, ensuring they accurately reflect clinical data, adhere to the core scientific narrative, and are compliant with all internal and external regulations. This position reports directly to the Associate Director, CNS Scientific Communications.
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**Key Responsibilities Include:**
**Core Content Development**
+ Under the guidance of the Associate Director, Medical Communications, draft and maintain high-priority, foundational scientific communication core materials, including:
+ Core Disease State Decks
+ Core Field Materials
+ Medical Publications
+ New Data Reporting
+ Medical Information Content Generation
**Scientific Accuracy and Consistency**
+ Ensure all content adheres to the approved core scientific narrative and lexicon, accurately reflects clinical trial data, and maintains consistency across global materials
+ Maintain content repositories and ensure version control and accessibility for global teams
+ Utilize platforms like Veeva Vault, to manage content lifecycle and Medical Review submissions.
+ Track and report content usage and effectiveness, providing insights for optimization
**Data Integration**
+ Collaborate with Clinical Development and Research teams to integrate new data from clinical study reports or publications into existing core content
**Cross-Functional Collaboration**
+ Act as key support resource for the Field Medical Affairs team, managing the content repository and version control for field-facing materials
+ Partner with external medical writing agencies, providing operational input and feedback, reviewing drafts for scientific accuracy, and ensuring deliverables align with project timelines
+ Ensure all content creation and review processes adhere to internal Standard Operating Procedures (SOPs), Good Publication Practices (GPP), and global regulatory guidelines
**Medical Information Content Generation**
+ Develop, review, and maintain high-quality, scientifically accurate medical information content for relevant therapeutic area products, including standard response letters, FAQs, and global core content.
+ Ensure all content complies with regulatory, legal, and medical standards, and is aligned with product strategy and scientific messaging.
+ Collaborate cross-functionally with Medical Affairs, Regulatory, Legal, and Commercial teams to ensure consistency and accuracy of medical communications.
+ Support the global-to-local adaptation of core content for use by regional and affiliate medical teams.
+ Serve as a champion for Medical Review / Promotional review processes for materials
+ Manage content lifecycle processes, including version control, periodic review, and archiving in content management systems (e.g., Veeva Vault).
+ Partner with external vendors and internal stakeholders to ensure timely and efficient content development and approval.
+ Monitor scientific literature and product data to ensure content reflects the most current evidence and clinical guidance.
+ Contribute to the development and implementation of content governance frameworks and best practices.
+ Provide training and guidance to internal stakeholders on the appropriate use of medical information content.
+ Consider technology and AI to support workflow improvement
**Qualifications**
**Education and Experience:**
+ Advanced scientific degree is strongly preferred (PharmD, MD, PhD, or equivalent) with expertise in Neuroscience or a related field
+ Minimum of 4+ years of applied experience in Medical Affairs, Scientific Communications, Medical Writing, and/or medical information within the pharmaceutical or biotechnology industry
+ Proven experience in the development and writing of core medical affairs content (e.g., scientific decks, disease state materials)
+ Experience working with medical writing agencies and managing content projects against strict timelines
**Skills and Competencies:**
+ Ability to interpret complex scientific data and translate it into clear, concise, and scientifically accurate communication materials for a professional medical audience
+ Strong focus on accuracy, consistency, and quality assurance in content creation and version control
+ Demonstrated ability to manage multiple content projects and deadlines independently within defined scope and guidance
+ Strong verbal and written communication skills to collaborate effectively with internal cross-functional partners and external vendors
+ Foundational understanding of the principles governing scientific and medical communications, including GPP and regulatory compliance requirements
**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 $117,027.00 - Maximum $175,030.00, 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) .
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