Medical director jobs in Nashville, TN

The Clinical Director is supervised by the CEO The Clinical Director supervises: Clinical Staff The Clinical Director: Assures a work environment that recruits, retains, and supports quality staff and volunteers Assures process for selecting, developing, motivating, and evaluating staff. Recruits personnel, negotiates professional contracts, and sees that appropriate salary structures are developed and maintained. Specifies accountabilities for management personnel and evaluates performance regularly. Oversees clinical program, audits charts, provides clinical supervision. The Clinical Director does not prescribe or administer medications. Duties: Coordinate with other disciplines to provide highest level of care Attends treatment team and staff meetings Provides staff supervision and training Oversees clinical program Oversees quality of treatment and documentation Other duties as assigned As Needed: Counseling duties as needed and documents in a secure EHR Diagnosing, writing progress notes, providing therapy Intake and admissions Including the BPS The Clinical Director maintains resident Electronic Health Records (EHR) documents in the resident file per the APA ethical codes, organization policies, state and federal regulations, and The Joint Commission Standards. Competencies and Abilities Able to manage a team and delegate tasks Able to track organization progress Able to manage budget Identify needs for staff training Able to identify gaps in organization performance Collaborate to make treatment plans and recommendations Perform screenings regarding alcohol and drugs Abide by ethical codes of the APA and CCAPP Qualifications: Minimum two years of supervisory experience in the industry of addiction treatment. May be registered, licensed, or certified Two years clean and sober if in recovery Current CPR and First Aid Certification on file Current TB skin test and health screen report Knowledge: Twelve Step Recovery Program Social Model detox Supervising a team Training and educating Gathering data Managing a budget Community resources and referral techniques Working with addiction and dual diagnosis Knowledge shall include the signs and symptoms of alcohol and other drug intoxication and withdrawal, as well managing a business in the industry of addiction treatment. The handling of medical consultations and referrals shall be a necessity for emergencies. Skills: Good listener Good with data entry Good leader and teacher Good at writing content

is incentive eligible. $15,000 Sign On Bonus Offered! Introduction Do you have the career opportunities as a Hospital Laboratory Director you want with your current employer? We have an exciting opportunity foryou to join TriStar Centennial Medical Center which is part of the nation's leading provider of healthcare services, HCA Healthcare. Benefits TriStar Centennial Medical Center offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include: Comprehensive medical coverage that covers many common services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed medical transportation. Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more. Free counseling services and resources for emotional, physical and financial wellbeing 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service) Employee Stock Purchase Plan with 10% off HCA Healthcare stock Family support through fertility and family building benefits with Progyny and adoption assistance. Referral services for child, elder and pet care, home and auto repair, event planning and more Consumer discounts through Abenity and Consumer Discounts Retirement readiness, rollover assistance services and preferred banking partnerships Education assistance (tuition, student loan, certification support, dependent scholarships) Colleague recognition program Time Away From Work Program (paid time off, paid family leave, long- and short-term disability coverage and leaves of absence) Employee Health Assistance Fund that offers free employee-only coverage to full-time and part-time colleagues based on income. Learn more about Employee Benefits Note: Eligibility for benefits may vary by location. Our teams are a committed, caring group of colleagues. Do you want to work as a Hospital Laboratory Director where your passion for creating positive patient interactions is valued? If you are dedicated to caring for the well-being of others, this could be your next opportunity. We want your knowledge and expertise! Job Summary and Qualifications DUTIES INCLUDE BUT NOT LIMITED TO: Directs operations, programs and activities to meet organizational and regulatory requirements and to drive innovation. Ensures adequate and qualified staffing for the department through timeliness and consistency of staff hiring, orientation, competency, training, performance feedback and performance management. Develops and recognizes staff through coaching and regular feedback. Serves as a role model for employee output and conduct. Sets and executes department strategies to meet goals for service, quality, regulatory compliance, financial, patient satisfaction and personnel management. Proactively and regularly seeks feedback and input from internal and external sources. Evaluates and incorporates feedback into the department improvement and planning process to improve care delivery. Oversees the financial operation for the laboratory by monitoring resource utilization, identifying variances and opportunities, and adjusting as needed to meet service and fiscal goals. Prepares Monthly Operating Review report. Assures compliance with standards set forth by accrediting agencies: CAP, JCAHO, CLIA, FDA and CMS. Develops and implements policies and procedures and verifies annual review of all policies and procedures. Manages key vendor relationships and supply contracts in coordination with Laboratory Services and Supply Chain guidance. Develops and implements a communication plan to ensure that department personnel are well informed. Fosters open communication by offering, encouraging, and accepting suggestions from staff regarding department operations Directs and organizes operations through the appropriate, delegation of responsibilities and authority in accordance with regulatory guidelines. Monitors and evaluates the activities of the staff and provides management, coaching, guidance, delegation opportunities, and on-the-job training and re-training as necessary to ensure operational efficiency and adherence to policies and procedures What qualifications you will need: Baccalaureate Degree in Medical Technology, Biomedical Science, Biology or Chemistry required. Master's Degree preferred National Certification as a Medical Technologist required. 5 years or more of progressive laboratory management experience is required with complex laboratory operations, required. Hospital clinical laboratory experience preferred This role requires you to be fully vaccinated for COVID-19 based on local, state and /or federal law or regulations (unless a medical or religious exemption is approved). HCA Healthcare Laboratory Services is a full-service provider of clinical laboratory and anatomic pathology services, providing hospitals, physicians, and clients with timely diagnostic information for patient care. Our infrastructure includes a fully automated esoteric core laboratory in Fort Lauderdale, a histology and microbiology operation in Largo, Florida, and a network of hospital-based rapid-response laboratories present in four HCA Healthcare divisions in Florida. Our core laboratories support more than 250 acute and rehab hospitals, physician practices, surgery centers, and commercial accounts. HCA Healthcare has been recognized as one of the World's Most Ethical Companies by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated $3.7 billion in costs for the delivery of charitable care, uninsured discounts, and other uncompensated expenses. "Bricks and mortar do not make a hospital. People do."- Dr. Thomas Frist, Sr. HCA Healthcare Co-Founder If you are looking for an opportunity that provides satisfaction and personal growth, we encourage you to apply for our Hospital Laboratory Director opening. We promptly review all applications. Highly qualified candidates will be contacted for interviews. Unlock the possibilities and apply today! We are an equal opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status. LAB-AFHP

is incentive eligible. $10,000 Sign On Bonus! Introduction Do you have the career opportunities as a Hospital Laboratory Director you want with your current employer? We have an exciting opportunity for you to join TriStar Southern Hills Medical Center which is part of the nation's leading provider of healthcare services, HCA Healthcare. Benefits TriStar Southern Hills Medical Center offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include: Comprehensive medical coverage that covers many common services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed medical transportation. Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more. Free counseling services and resources for emotional, physical and financial wellbeing 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service) Employee Stock Purchase Plan with 10% off HCA Healthcare stock Family support through fertility and family building benefits with Progyny and adoption assistance. Referral services for child, elder and pet care, home and auto repair, event planning and more Consumer discounts through Abenity and Consumer Discounts Retirement readiness, rollover assistance services and preferred banking partnerships Education assistance (tuition, student loan, certification support, dependent scholarships) Colleague recognition program Time Away From Work Program (paid time off, paid family leave, long- and short-term disability coverage and leaves of absence) Employee Health Assistance Fund that offers free employee-only coverage to full-time and part-time colleagues based on income. Learn more about Employee Benefits Note: Eligibility for benefits may vary by location. Our teams are a committed, caring group of colleagues. Do you want to work as a Hospital Laboratory Director where your passion for creating positive patient interactions is valued? If you are dedicated to caring for the well-being of others, this could be your next opportunity. We want your knowledge and expertise! Job Summary and Qualifications DUTIES INCLUDE BUT NOT LIMITED TO: Directs operations, programs and activities to meet organizational and regulatory requirements and to drive innovation. Ensures adequate and qualified staffing for the department through timeliness and consistency of staff hiring, orientation, competency, training, performance feedback and performance management. Develops and recognizes staff through coaching and regular feedback. Serves as a role model for employee output and conduct. Sets and executes department strategies to meet goals for service, quality, regulatory compliance, financial, patient satisfaction and personnel management. Proactively and regularly seeks feedback and input from internal and external sources. Evaluates and incorporates feedback into the department improvement and planning process to improve care delivery. Oversees the financial operation for the laboratory by monitoring resource utilization, identifying variances and opportunities, and adjusting as needed to meet service and fiscal goals. Prepares Monthly Operating Review report. Assures compliance with standards set forth by accrediting agencies: CAP, JCAHO, CLIA, FDA and CMS. Develops and implements policies and procedures and verifies annual review of all policies and procedures. Manages key vendor relationships and supply contracts in coordination with Laboratory Services and Supply Chain guidance. Develops and implements a communication plan to ensure that department personnel are well informed. Fosters open communication by offering, encouraging, and accepting suggestions from staff regarding department operations Directs and organizes operations through the appropriate, delegation of responsibilities and authority in accordance with regulatory guidelines. Monitors and evaluates the activities of the staff and provides management, coaching, guidance, delegation opportunities, and on-the-job training and re-training as necessary to ensure operational efficiency and adherence to policies and procedures What qualifications you will need: Baccalaureate Degree in Medical Technology, Biomedical Science, Biology or Chemistry required. Master's Degree preferred National Certification as a Medical Technologist required. 5 years or more of progressive laboratory management experience is required with complex laboratory operations, required. Hospital clinical laboratory experience preferred This role requires you to be fully vaccinated for COVID-19 based on local, state and /or federal law or regulations (unless a medical or religious exemption is approved). HCA Healthcare Laboratory Services is a full-service provider of clinical laboratory and anatomic pathology services, providing hospitals, physicians, and clients with timely diagnostic information for patient care. Our infrastructure includes a fully automated esoteric core laboratory in Fort Lauderdale, a histology and microbiology operation in Largo, Florida, and a network of hospital-based rapid-response laboratories present in four HCA Healthcare divisions in Florida. Our core laboratories support more than 250 acute and rehab hospitals, physician practices, surgery centers, and commercial accounts. HCA Healthcare has been recognized as one of the World's Most Ethical Companies by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated $3.7 billion in costs for the delivery of charitable care, uninsured discounts, and other uncompensated expenses. "Bricks and mortar do not make a hospital. People do."- Dr. Thomas Frist, Sr. HCA Healthcare Co-Founder If you are looking for an opportunity that provides satisfaction and personal growth, we encourage you to apply for our Hospital Laboratory Director opening. We promptly review all applications. Highly qualified candidates will be contacted for interviews. Unlock the possibilities and apply today! We are an equal opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status. LAB-AFHP

PathGroup is seeking an AP/CP Board-Certified Pathologist to serve as Laboratory Medical Director at our central reference laboratory in Nashville, TN. This leadership position offers a unique opportunity to oversee laboratory operations, ensure regulatory compliance, and support diagnostic excellence across one of the nation's largest independent pathology groups. The role is ideal for a dynamic, forward-thinking pathologist who brings both clinical acumen and administrative experience to a fast-paced, high-volume environment. Highlights: Lead a CAP-accredited, high-complexity reference laboratory serving a national client base No autopsy requirement Collaborate with a team of subspecialized pathologists and laboratory leaders Contribute to lab quality initiatives, accreditation standards, and compliance protocols Opportunity to shape clinical standards and operational excellence across the organization About the Practice: Based at PathGroup's national headquarters and central lab in Nashville Integrated services include surgical pathology, hematopathology, cytopathology, molecular diagnostics, microbiology, and more Supports multiple hospital systems, outpatient clinics, and physician practices across the country Robust IT, operations, and quality infrastructure to support innovation and compliance About Nashville, TN: Rapidly growing city with a strong reputation in healthcare, research, and medical innovation Vibrant downtown scene, excellent schools, and abundant family-friendly neighborhoods Easy access to nature, parks, and recreational lakes Major airport with national reach Why PathGroup? Largest Independent Private Pathology Group in the U.S.: Join a well-established, physician-led organization with a reputation for excellence. Physician-Led Decision-Making: Your voice matters in shaping clinical practice and organizational direction. Collaborative & Supportive Culture: Work in an environment where teamwork is valued, knowledge is shared, and expert pathologists across every subspecialty support one another. Innovative Digital Pathology: Leverage cutting-edge technology for efficiency and advanced diagnostic abilities. Work-Life Balance: Receive the support you need to maintain a fulfilling career and personal life, with generous PTO included. Growth & Development: Take advantage of professional development opportunities, training expansion, project collaboration, and other academic-style professional activities. Competitive Compensation & Benefits: Receive a competitive salary, malpractice coverage (including tail), full benefits, and a 401(k) Safe Harbor Plan. Key Responsibilities: Provide medical and administrative leadership at PathGroup's central laboratory Oversee quality systems, regulatory compliance, and laboratory inspections Collaborate with subspecialty pathologists, lab operations teams, and client services Represent the lab in client-facing discussions, clinical consultations, and internal strategic meetings Lead or support laboratory quality improvement initiatives

Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations can be considered. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. Work schedule: Monday - Friday. Half day Saturday rotation, once a month. The Medical Director is responsible for the administration of behavioral health medical services, to ensure the appropriate and most cost-effective medical care is received. May be responsible for developing and implementing programs to improve quality, cost, and outcomes. May provide clinical consultation and serve as clinical/strategic advisor to enhance clinical operations. May identify cost of care opportunities. How you will make an impact: * Supports clinicians to ensure timely and consistent responses to members and providers. * Provides guidance for clinical operational aspects of a program. * Conduct peer-to-peer clinical appeal case reviews with attending physicians or other ordering providers to discuss review determinations. * Serves as a resource and consultant to other areas of the company. * May be required to represent the company to external entities and/or serve on internal and/or external committees. May chair company committees. * Interprets medical policies and clinical guidelines. May develop and propose new medical policies based on changes in healthcare. * Leads, develops, directs, and implements clinical and non-clinical activities that impact health care quality cost and outcomes. * Identifies and develops opportunities for innovation to increase effectiveness and quality. * Provides oversight, direction, and guidance to Medical Director Associates. * Works independently with oversight from immediate manager. * May be responsible for an entire clinical program and/or independently performs clinical reviews. * Typically has program management responsibilities including clinical policy development, improvement of quality, cost, and outcomes, program development/implementation, and overseeing clinical/non-clinical activities. Minimum Qualifications: * Requires MD or DO and Board certification approved by one of the following certifying boards is required, where applicable to duties being performed, American Board of Medical Specialties (ABMS) or American Osteopathic Association (AOA). * Must possess an active unrestricted medical license to practice medicine or a health profession. * Unless expressly allowed by state or federal law, or regulation, must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US military base, vessel or any embassy located in or outside of the US. * Minimum of 10 years of clinical experience; or any combination of education and experience, which would provide an equivalent background. * For Health Solutions and Carelon organizations (including Behavioral Health) only, minimum of 5 years of experience providing health care is required. * Additional experience may be required by State contracts or regulations if the Medical Director is filing a role required by a State agency. Preferred Skills, Capabilities and Experiences: * Child and Adolescent experience preferred. * Utilization Management experience. * Applied Behavior Analysis (ABA) experience. * An active unrestricted medical license to practice medicine or a health profession in California or ability to obtain upon hire. For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $274,068 to $428,976. Locations: Costa Mesa, CA, Walnut Creek, CA, Woodland Hills, CA In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws. * The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law. Job Level: Director Equivalent Workshift: Job Family: MED > Licensed Physician/Doctor/Dentist Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ******************************************** for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

**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 *************************************************************

Job Details TN, Nashville - Debra Johnson Rehab Center - Nashville, TN Part-Time Professional Degree Day Medical Physician & Advanced Practice ProviderDescription Centurion Health is proud to be the provider of comprehensive healthcare services to the Tennessee Department of Correction. We are currently seeking a part-time (20 hours per week) Site Medical Director to join our team at the Debra K. Johnson Rehabilitation Center located in Nashville, Tennessee. The Medical Director provides the clinical direction needed to meet service delivery requirements, direct clinical services for patients, and clinical supervision for medical staff at the assigned site under the supervision of the Statewide Medical Director. The Medical Director collaborates with the Health Services Administrator (HSA) to ensure efficient and clinically appropriate medical services are provided, and participates in various committees to include Continuous Quality Improvement (CQI), Infection Prevention and Control, and Pharmacy and Therapeutics as requested. Qualifications • Medical degree (MD or DO) from an accredited medical school required • Active and unrestricted TN MD/DO license or the ability to obtain one required • Board certification in Family Medicine, Internal Medicine, or Emergency Medicine required • Must show/be able to obtain active Drug Enforcement Administration (DEA) registration • Leadership/directorship experience preferred • Ability to pass credentialing and background check Available Shift Monday, Tuesday and 1/2 day another day (preferably Fridays) Day shift No nights, holidays or weekends PAID Call Centurion Health provides company paid medical malpractice insurance for our part-time providers. For additional information, contact Tiffany Walden, Provider Recruiter at ************************* or call/text ************. indmhm

Medical Director ( Remote ) A growing outpatient facility company is hiring for a Remote Medical Director to perform following responsibilities Provide clinical consultation and serve as strategic adviser Implement clinical and non-clinical initiatives to improve health care quality cost Support clinicians and provide guidance for clinical operations Conduct clinical reviews and propose new medical policies Requirements Atleast 7 years Relevant experience MD in in Psychiatry and State Medical License If you are interested in the above opportunity please apply. Only relevant candidates will be contacted. workforcesolutionsvirensglobal... Locations: America, Europe, Asia & Australia

Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be considered. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. The Medical Director-Dermatology Appeals is responsible for the review of appeals for physical health medical services, to ensure the appropriate and most cost-effective medical care is received. May be responsible for developing and implementing programs to improve quality, cost, and outcomes. May provide clinical consultation and serve as clinical/strategic advisor to enhance clinical operations. May identify cost of care opportunities. May serve as a resource to staff including Medical Director Associates. May be responsible for an entire clinical program. How you will make an impact: * Complete appeal reviews in your specialty daily to ensure timely and consistent responses to members and providers. * Provide guidance for clinical operational aspects of a program. * May conduct peer-to-peer clinical reviews with attending physicians or other providers to discuss review determinations * Serve as a resource and consultant to other areas of the company. * May be required to represent the company to external entities and/or serve on internal and/or external committees. * May chair company committees. * Interpret medical policies and clinical guidelines. * May lead, develop, direct, and implement clinical and non-clinical activities that impact health care quality cost and outcomes. * Identify and develop opportunities for innovation to increase effectiveness and quality. * Work independently with oversight from immediate manager. * May be responsible for an entire clinical program and/or independently perform clinical reviews. Minimum Qualifications * Requires MD or DO and Board certification approved by one of the following certifying boards is required, where applicable to duties being performed: American Board of Medical Specialties (ABMS) or American Osteopathic Association (AOA). * Board certification in Dermatology. * Must possess an active unrestricted medical license to practice medicine or a health profession. Unless expressly allowed by state or federal law, or regulation, must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US military base, vessel or any embassy located in or outside of the US. * Minimum of 10 years of clinical experience; or any combination of education and experience, which would provide an equivalent background. * For Health Solutions and Carelon organizations (including behavioral health) only, minimum of 5 years of experience providing health care is required. * Additional experience may be required by State contracts or regulations if the Medical Director is filling a role required by a State agency. * For URAC accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written, and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills. If this job is assigned to any Government Business Division entity, the applicant and incumbent fall under a sensitive position work designation and may be subject to additional requirements beyond those associates outside Government Business Divisions. Requirements include but are not limited to more stringent and frequent background checks and/or government clearances, segregation of duties, principles, role specific training, monitoring of daily job functions, and sensitive data handling instructions. Associates in these jobs must follow the specific policies, procedures, guidelines, etc. as stated by the Government Business Division in which they are employed. Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ******************************************** for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

Job DescriptionDescription: Medical Director - Full-Time Psychiatrist (MD) Schedule: Monday - Friday Call: One Weekend per Month Salary Range: $300,000 - $350,000+ (Additional compensation available for expanded responsibilities) Position Overview: River Region Psychiatry Associates is seeking a full-time Medical Director (MD) to lead psychiatric services at Pinewood Springs. This leadership role offers an opportunity to shape inpatient behavioral health care while maintaining a balanced schedule and working with a strong clinical team. Key Responsibilities: Serve as Medical Director for Pinewood Springs, overseeing clinical operations and psychiatric care Provide direct psychiatric services to patients in an inpatient setting Participate in weekend call coverage one weekend per month (Optional) Expand role to include outpatient coverage at our Franklin Clinic, with additional compensation based on scope What We Offer: Competitive base salary: $300,000 - $350,000+, with potential for additional earnings tied to expanded services or responsibilities Supportive team and leadership structure Opportunity to influence care delivery and program development Optional outpatient clinic work to diversify clinical scope and increase compensation Join River Region Psychiatry Associates and help lead the delivery of high-quality mental health care at Pinewood Springs. We're looking for a dynamic psychiatrist ready to make a meaningful impact in a growing program. Requirements: Qualifications: MD or DO with Board Certification/Eligibility in Psychiatry Eligible for medical licensure in Tennessee Prior leadership experience preferred but not required Strong clinical, collaborative, and organizational skills Take the Next Step in Your Career! If you are a dedicated psychiatrist seeking a rewarding opportunity to make a lasting impact in mental health care, we invite you to join our team. Submit your CV today to apply!

Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but for more than seven decades we've been part of the national landscape, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina … and much more. We are one of the nation's leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies that allows us to build on a variety of business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team! Position Purpose: The Medical Review Director directs and oversees operations in the medical review, clinical pricing, and re-determination areas ensuring performance expectations, compliance standards, and budgetary limits are maintained. In this role, you will supervise and motivate area employees. Description Logistics: CGS Administrators, LLC - one of BlueCross BlueShield of South Carolina's subsidiary companies. Location: This position is full-time (40-hours/week) Monday-Friday ONSITE in a typical office environment. You will work an 8-hour shift scheduled during our normal business hours of 8:00AM-5:00PM. It may be necessary, given the business need to work occasional overtime. You may be required to travel between buildings. This role can be physically located in Nashville, TN, Columbia, SC, or Springfield, IL. There are no options for remote or hybrid work schedules. Government Clearance: This position requires the ability to obtain a security clearance, which requires applicants to be a U.S. Citizen. What You'll Do: Oversees operations of assigned areas. Coordinates tactical team activities. Ensures area review decisions are accurate and all associates are well informed and trained on contract process work instructions. Reviews and analyzes data and creates departmental strategy and error rate reduction plans based on the findings. Provides guidance on the analysis, identification, and corrective actions of services and/or providers with suspected abuse of the program. Works closely with the Provider Service Center and other internal departments, providing necessary assistance and resources, to ensure consistency and achieve the integrated goals of reducing the claims payment error rate and procurement of additional contracts. Develops and monitors budget for all assigned areas. To Qualify For This Position, You'll Need The Following: Required Education: Bachelor's in a job related field. Required Experience: 5 years healthcare program management, utilization/case management, or medical review management. 3 years of supervisory/management experience or equivalent military experience in grade E4 or above. Required Software and tools: Microsoft Office. Knowledge of medical systems software. Required Skills and Abilities: Excellent verbal and written communication skills. Excellent organizational, customer service, analytical or critical thinking skills. Excellent presentation skills. Good judgment skills. Ability to persuade, negotiate, or influence others. We Prefer That You Have The Following: Bachelor's degree - Nursing Graduate of Accredited School of Nursing Experience working with CMS and/or Medicare. Working knowledge of Medicare claims processes and the Medicare program. Strong understanding of using data to make business decision. Knowledge/understanding of utilization review guidelines, managed care delivery systems. Ability to work independently, prioritize effectively, make sound decisions. Demonstrated presentation skills in order to work effectively with both internal and external customers. Ability to handle confidential or sensitive information with discretion. Ability to direct, motivate, and assess performance of others. Preferred Licenses and Certificates: Active RN licensure in state hired. Work Environment: Typical office environment frequent. Travel between office buildings. Some out of town travel. Our Comprehensive Benefits Package Includes The Following: We offer our employees great benefits and rewards. You will be eligible to participate in the benefits the first of the month following 28 days of employment. Subsidized health plans, dental and vision coverage 401k retirement savings plan with company match Life Insurance Paid Time Off (PTO) On-site cafeterias and fitness centers in major locations Education Assistance Service Recognition National discounts to movies, theaters, zoos, theme parks and more What We Can Do for You: We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company. What To Expect Next: After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements. Pay Range Information: Range Minimum $76,546.00 Range Midpoint $113,900.50 Range Maximum $151,255.00 Pay Transparency Statement: Please note that this range represents the pay range for this and other positions that fall into this pay grade. Compensation decisions within the range will be dependent upon a variety of factors, including experience, geographic location, and internal equity. Equal Employment Opportunity Statement BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilities and protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations. We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company. If you need special assistance or an accommodation while seeking employment, please email ************************ or call ************, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis. We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Here's more information. Some states have required notifications. Here's more information.

Medical Director in Russellville, KY! As a Medical Director, you will play a critical role in providing primary care and support to individuals within our organization. The Medical Director provides clinical oversight and leadership for a skilled nursing facility (SNF). This role ensures high-quality care, compliance with regulations, and collaboration with the healthcare team. The Medical Director will focus on the development and implementation of clinical protocols, effective communication with facility leadership, and the continuous improvement of patient outcomes. Why Join Our Team Are you looking for a career that will give your life purpose? Are you looking for a career choice that will affect people's lives in a positive way? If so, we have the right opportunity for you. Here with Telos Health Systems, we give you an opportunity to have a rewarding career, not just a job. Our goal is to help our associates grow their careers with our focus on development, a team-orientated atmosphere, and creating a great place to work. Here, you can make a difference by doing the work that you love while making a significant impact on people's lives and the communities we serve. Key Responsibilities: Clinical Leadership: Oversee the clinical care provided to residents, ensuring adherence to evidence-based protocols and guidelines. Collaborate with attending physicians, nursing staff, and interdisciplinary teams to establish, monitor, and improve resident care plans. Promote a culture of quality care, resident safety, and satisfaction within the facility. Compliance and Quality Improvement: Ensure compliance with state and federal healthcare regulations, including CMS and Department of Health standards. Lead quality improvement initiatives, including reduction of readmissions, effective medication management, and infection control. Act as a key resource during state and federal surveys, assisting with compliance and survey preparedness. Education and Training: Provide ongoing education and training to medical and nursing staff on topics such as best clinical practices, regulatory requirements, and new healthcare developments. Mentor healthcare providers and support professional development within the facility. Collaboration and Communication: Serve as the primary clinical liaison between the facility, hospital systems, and community providers. Maintain strong communication with families, staff, and residents regarding care plans, treatment updates, and changes in medical status. Participate in interdisciplinary team meetings, resident care conferences, and quality improvement committees. Utilization Review and Cost Management: Collaborate with the administrative team on the utilization review process, ensuring appropriate use of resources and cost-effective care delivery. Work to optimize reimbursement processes, improve documentation accuracy, and reduce unnecessary medical costs. Qualifications: MD or DO with active and unrestricted medical licensure in the state. Board-certified in Internal Medicine, Family Medicine, or Geriatrics preferred. Experience in a skilled nursing or long-term care setting. Strong knowledge of CMS guidelines, regulations, and reimbursement structures. Excellent leadership, communication, and organizational skills. Commitment to improving quality of care and patient outcomes. Strong knowledge of psychopharmacology and evidence-based psychotherapeutic modalities. Excellent communication skills, both verbal and written, with the ability to explain complex medical concepts to patients and colleagues. Empathy, compassion, and a patient-centered approach to care. Ability to work collaboratively within a multidisciplinary team. Familiarity with electronic health records (EHR) and other relevant medical software. Complete a full 90 Day Training Period as Facility Attending Physician under the purview of Telos Health Systems State CMO. Equal Employment Opportunity Employer Telos Health Systems will provide equal employment opportunities (EEO) to all associates and applicants for employment regardless of race, color, religion, national origin, gender, sexual orientation, gender identification or expression, age, disability, marital status, amnesty, genetic information, carrier status or any other legally protected status or status as a covered veteran in accordance with applicable federal, state and local laws.

**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.

SUMMARY: Blount Rural Health Center is in the market to fill a Part-Time Medical Director Position to provide medical direction for the clinic's health care services and consultation for, and medical collaboration/supervision of, mid-level providers. QUALIFICATIONS: Must be a graduate of an approved medical school, completed an internship and/or residency in his/her given specialty or be board eligible, insurability for professional liability, and be licensed as a physician in the State of Kentucky; demonstrate effective verbal and written communication skills, and ability to make quality independent decisions. ESSENTIAL JOB FUNCTIONS: Provides medical directorship for the clinic's healthcare services, consultation for, and medical supervision of mid-level providers. Maintains current licensure as required by federal and state boards, associations, and agencies and is credentialed in a primary care specialty. Fulfills all federal and state requirements for CME pursuant to licensure requirements. Actively and personally interacts with the clinical and licensed medical staff frequently enough to provide medical direction, consultation, and supervision per federal and state requirements; is available through direct telecommunications for consultation, medical emergencies, or patient referral in compliance with federal and state supervision and collaborative requirements; and is able to issue orders and provide direct patient care services, if needed. Provide general medical direction for the clinic concerning its patient care services. Conduct periodic assessments to ensure maintenance of quality controls as necessary for compliance with standards established by federal, state and other regulatory agencies. Perform various public relation activities to include meeting with local community groups or service organizations. Establish and maintain effective working relationships with area health care entities such as hospitals, physician practices, health departments, and other ancillary support groups. Collaborates with Quality Improvement Manager in setting goals to reach national benchmarks in identified areas in need of improvement. Collaborates with Executive Director with establishing new policies, updating current policies, and strategic goals for growth. In consultation with administration, assist in recruitment of other health care professionals as the demands of the practice dictate. BENEFITS: HRSA Loan Repayment Program Vison and Dental eligibility No Nights, Weekends or Holidays Competitive compensation. Malpractice insurance coverage. Retirement/401K

is incentive eligible. $15,000 Sign On Bonus Offered! Introduction Do you have the career opportunities as a Hospital Laboratory Director you want with your current employer? We have an exciting opportunity foryou to join TriStar Centennial Medical Center which is part of the nation's leading provider of healthcare services, HCA Healthcare. Benefits TriStar Centennial Medical Center offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include: Comprehensive medical coverage that covers many common services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed medical transportation. Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more. Free counseling services and resources for emotional, physical and financial wellbeing 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service) Employee Stock Purchase Plan with 10% off HCA Healthcare stock Family support through fertility and family building benefits with Progyny and adoption assistance. Referral services for child, elder and pet care, home and auto repair, event planning and more Consumer discounts through Abenity and Consumer Discounts Retirement readiness, rollover assistance services and preferred banking partnerships Education assistance (tuition, student loan, certification support, dependent scholarships) Colleague recognition program Time Away From Work Program (paid time off, paid family leave, long- and short-term disability coverage and leaves of absence) Employee Health Assistance Fund that offers free employee-only coverage to full-time and part-time colleagues based on income. Learn more about Employee Benefits Note: Eligibility for benefits may vary by location. Our teams are a committed, caring group of colleagues. Do you want to work as a Hospital Laboratory Director where your passion for creating positive patient interactions is valued? If you are dedicated to caring for the well-being of others, this could be your next opportunity. We want your knowledge and expertise! Job Summary and Qualifications DUTIES INCLUDE BUT NOT LIMITED TO: Directs operations, programs and activities to meet organizational and regulatory requirements and to drive innovation. Ensures adequate and qualified staffing for the department through timeliness and consistency of staff hiring, orientation, competency, training, performance feedback and performance management. Develops and recognizes staff through coaching and regular feedback. Serves as a role model for employee output and conduct. Sets and executes department strategies to meet goals for service, quality, regulatory compliance, financial, patient satisfaction and personnel management. Proactively and regularly seeks feedback and input from internal and external sources. Evaluates and incorporates feedback into the department improvement and planning process to improve care delivery. Oversees the financial operation for the laboratory by monitoring resource utilization, identifying variances and opportunities, and adjusting as needed to meet service and fiscal goals. Prepares Monthly Operating Review report. Assures compliance with standards set forth by accrediting agencies: CAP, JCAHO, CLIA, FDA and CMS. Develops and implements policies and procedures and verifies annual review of all policies and procedures. Manages key vendor relationships and supply contracts in coordination with Laboratory Services and Supply Chain guidance. Develops and implements a communication plan to ensure that department personnel are well informed. Fosters open communication by offering, encouraging, and accepting suggestions from staff regarding department operations Directs and organizes operations through the appropriate, delegation of responsibilities and authority in accordance with regulatory guidelines. Monitors and evaluates the activities of the staff and provides management, coaching, guidance, delegation opportunities, and on-the-job training and re-training as necessary to ensure operational efficiency and adherence to policies and procedures What qualifications you will need: Baccalaureate Degree in Medical Technology, Biomedical Science, Biology or Chemistry required. Master's Degree preferred National Certification as a Medical Technologist required. 5 years or more of progressive laboratory management experience is required with complex laboratory operations, required. Hospital clinical laboratory experience preferred This role requires you to be fully vaccinated for COVID-19 based on local, state and /or federal law or regulations (unless a medical or religious exemption is approved). HCA Healthcare Laboratory Services is a full-service provider of clinical laboratory and anatomic pathology services, providing hospitals, physicians, and clients with timely diagnostic information for patient care. Our infrastructure includes a fully automated esoteric core laboratory in Fort Lauderdale, a histology and microbiology operation in Largo, Florida, and a network of hospital-based rapid-response laboratories present in four HCA Healthcare divisions in Florida. Our core laboratories support more than 250 acute and rehab hospitals, physician practices, surgery centers, and commercial accounts. HCA Healthcare has been recognized as one of the World's Most Ethical Companies by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated $3.7 billion in costs for the delivery of charitable care, uninsured discounts, and other uncompensated expenses. "Bricks and mortar do not make a hospital. People do."- Dr. Thomas Frist, Sr. HCA Healthcare Co-Founder If you are looking for an opportunity that provides satisfaction and personal growth, we encourage you to apply for our Hospital Laboratory Director opening. We promptly review all applications. Highly qualified candidates will be contacted for interviews. Unlock the possibilities and apply today! We are an equal opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status. LAB-AFHP

is incentive eligible. $10,000 Sign On Bonus! Introduction Do you have the career opportunities as a Hospital Laboratory Director you want with your current employer? We have an exciting opportunity for you to join TriStar Southern Hills Medical Center which is part of the nation's leading provider of healthcare services, HCA Healthcare. Benefits TriStar Southern Hills Medical Center offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include: Comprehensive medical coverage that covers many common services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed medical transportation. Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more. Free counseling services and resources for emotional, physical and financial wellbeing 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service) Employee Stock Purchase Plan with 10% off HCA Healthcare stock Family support through fertility and family building benefits with Progyny and adoption assistance. Referral services for child, elder and pet care, home and auto repair, event planning and more Consumer discounts through Abenity and Consumer Discounts Retirement readiness, rollover assistance services and preferred banking partnerships Education assistance (tuition, student loan, certification support, dependent scholarships) Colleague recognition program Time Away From Work Program (paid time off, paid family leave, long- and short-term disability coverage and leaves of absence) Employee Health Assistance Fund that offers free employee-only coverage to full-time and part-time colleagues based on income. Learn more about Employee Benefits Note: Eligibility for benefits may vary by location. Our teams are a committed, caring group of colleagues. Do you want to work as a Hospital Laboratory Director where your passion for creating positive patient interactions is valued? If you are dedicated to caring for the well-being of others, this could be your next opportunity. We want your knowledge and expertise! Job Summary and Qualifications DUTIES INCLUDE BUT NOT LIMITED TO: Directs operations, programs and activities to meet organizational and regulatory requirements and to drive innovation. Ensures adequate and qualified staffing for the department through timeliness and consistency of staff hiring, orientation, competency, training, performance feedback and performance management. Develops and recognizes staff through coaching and regular feedback. Serves as a role model for employee output and conduct. Sets and executes department strategies to meet goals for service, quality, regulatory compliance, financial, patient satisfaction and personnel management. Proactively and regularly seeks feedback and input from internal and external sources. Evaluates and incorporates feedback into the department improvement and planning process to improve care delivery. Oversees the financial operation for the laboratory by monitoring resource utilization, identifying variances and opportunities, and adjusting as needed to meet service and fiscal goals. Prepares Monthly Operating Review report. Assures compliance with standards set forth by accrediting agencies: CAP, JCAHO, CLIA, FDA and CMS. Develops and implements policies and procedures and verifies annual review of all policies and procedures. Manages key vendor relationships and supply contracts in coordination with Laboratory Services and Supply Chain guidance. Develops and implements a communication plan to ensure that department personnel are well informed. Fosters open communication by offering, encouraging, and accepting suggestions from staff regarding department operations Directs and organizes operations through the appropriate, delegation of responsibilities and authority in accordance with regulatory guidelines. Monitors and evaluates the activities of the staff and provides management, coaching, guidance, delegation opportunities, and on-the-job training and re-training as necessary to ensure operational efficiency and adherence to policies and procedures What qualifications you will need: Baccalaureate Degree in Medical Technology, Biomedical Science, Biology or Chemistry required. Master's Degree preferred National Certification as a Medical Technologist required. 5 years or more of progressive laboratory management experience is required with complex laboratory operations, required. Hospital clinical laboratory experience preferred This role requires you to be fully vaccinated for COVID-19 based on local, state and /or federal law or regulations (unless a medical or religious exemption is approved). HCA Healthcare Laboratory Services is a full-service provider of clinical laboratory and anatomic pathology services, providing hospitals, physicians, and clients with timely diagnostic information for patient care. Our infrastructure includes a fully automated esoteric core laboratory in Fort Lauderdale, a histology and microbiology operation in Largo, Florida, and a network of hospital-based rapid-response laboratories present in four HCA Healthcare divisions in Florida. Our core laboratories support more than 250 acute and rehab hospitals, physician practices, surgery centers, and commercial accounts. HCA Healthcare has been recognized as one of the World's Most Ethical Companies by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated $3.7 billion in costs for the delivery of charitable care, uninsured discounts, and other uncompensated expenses. "Bricks and mortar do not make a hospital. People do."- Dr. Thomas Frist, Sr. HCA Healthcare Co-Founder If you are looking for an opportunity that provides satisfaction and personal growth, we encourage you to apply for our Hospital Laboratory Director opening. We promptly review all applications. Highly qualified candidates will be contacted for interviews. Unlock the possibilities and apply today! We are an equal opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status. LAB-AFHP

**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 *************************************************************

Job Details TN, Nashville - Tennessee Regional Office - Nashville, TN Full-Time Professional Degree Day LeadershipDescription Centurion Health is proud to be the provider of comprehensive healthcare services to the Tennessee Department of Correction. We are currently seeking a full-time primary care physician to join our team as a Statewide Medical Director. This position is based out of our Tennessee Regional Office located in Nashville, Tennessee. The Statewide Medical Director provides the comprehensive medical, clinical, and utilization management direction needed to meet the service delivery requirements of a specific contract in collaboration with the Vice President of Operations (VPO) and/or Regional Vice President of Operations (RVP). The Statewide Medical Director mentors, clinically supervises, and evaluates the team-delivered medical services for the patients at all facilities of the contract and promotes the culture of quality medical care using evidence-based standards of care. This professional serves as the contract's clinical expert, provider resource, clinical and medical management leader, and clinical outcomes driver while representing correctional healthcare to the client and the contract's providers. Qualifications MD or DO Board certified in IM, FM or EM Active, unrestricted TN medical license or ability to obtain Active, unrestricted DEA Minimum of 1-2 years clinical experience Correctional healthcare experience preferred, but not required Ability to pass background screening, drug test and credentialing Available Shift Monday-Friday Day Shift No nights, holidays or weekends We offer excellent compensation and comprehensive benefits for our full-time team members including: Health, dental, vision, disability and life insurance 401(k) with company match Company paid malpractice insurance Generous paid time off Paid holidays Flexible Spending account Continuing education benefits Much more... Centurion Health contracts with state and local governments nationwide to provide comprehensive healthcare services to correctional facilities, state hospitals, and other community settings. Our dedication to making a difference and our passionate team of the best and the brightest healthcare employees has made us one of the leaders of the correctional health industry. Whether you are driven by purpose and impact or on a journey of professional growth, our opportunities can offer both. For additional information, please contact Tiffany Walden, Provider Recruiter at ************************* or call/text: ************ indmhm

**Location:** This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be considered. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. The **Medical Director-Dermatology Appeals** is responsible for the review of appeals for physical health medical services, to ensure the appropriate and most cost-effective medical care is received. May be responsible for developing and implementing programs to improve quality, cost, and outcomes. May provide clinical consultation and serve as clinical/strategic advisor to enhance clinical operations. May identify cost of care opportunities. May serve as a resource to staff including Medical Director Associates. May be responsible for an entire clinical program. **How you will make an impact:** + Complete appeal reviews in your specialty daily to ensure timely and consistent responses to members and providers. + Provide guidance for clinical operational aspects of a program. + May conduct peer-to-peer clinical reviews with attending physicians or other providers to discuss review determinations + Serve as a resource and consultant to other areas of the company. + May be required to represent the company to external entities and/or serve on internal and/or external committees. + May chair company committees. + Interpret medical policies and clinical guidelines. + May lead, develop, direct, and implement clinical and non-clinical activities that impact health care quality cost and outcomes. + Identify and develop opportunities for innovation to increase effectiveness and quality. + Work independently with oversight from immediate manager. + May be responsible for an entire clinical program and/or independently perform clinical reviews. **Minimum Qualifications** + Requires MD or DO and Board certification approved by one of the following certifying boards is required, where applicable to duties being performed: American Board of Medical Specialties (ABMS) or American Osteopathic Association (AOA). + Board certification in Dermatology. + Must possess an active unrestricted medical license to practice medicine or a health profession. Unless expressly allowed by state or federal law, or regulation, must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US military base, vessel or any embassy located in or outside of the US. + Minimum of 10 years of clinical experience; or any combination of education and experience, which would provide an equivalent background. + For Health Solutions and Carelon organizations (including behavioral health) only, minimum of 5 years of experience providing health care is required. + Additional experience may be required by State contracts or regulations if the Medical Director is filling a role required by a State agency. + For URAC accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written, and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills. If this job is assigned to any Government Business Division entity, the applicant and incumbent fall under a sensitive position work designation and may be subject to additional requirements beyond those associates outside Government Business Divisions. Requirements include but are not limited to more stringent and frequent background checks and/or government clearances, segregation of duties, principles, role specific training, monitoring of daily job functions, and sensitive data handling instructions. Associates in these jobs must follow the specific policies, procedures, guidelines, etc. as stated by the Government Business Division in which they are employed. Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ******************************************** for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.