Medical director jobs in Noblesville, IN

Surgical Services Clinical Manager - Operating Room & Periop Indianapolis, IN Full-Time | Monday-Friday We are seeking an experienced and dynamic Surgical Services Clinical Manager to lead our operating room and PPOP-PACU teams in a high-acuity, fast-paced surgical environment. Team Oversight The Surgical Services Clinical Manager is responsible for the daily management of approximately 53 direct reports, including: Surgical Department: 12 Registered Nurses (RNs) 1 Surgical Assistant 9 Certified Surgical Technologists 2 Radiology Technologists PPOP-PACU Department: 25 Registered Nurses (RNs) 3 Certified Nursing Assistants (CNAs) Key Responsibilities Oversee day-to-day operations in the OR, Pre-op, PACU, and Post-op areas Provide leadership and mentorship to clinical staff Collaborate with surgeons and multidisciplinary teams to ensure safe, efficient care Ensure regulatory compliance, staffing, and scheduling standards are met Foster a culture of excellence, safety, and continuous improvement Required Qualifications Bachelor of Science in Nursing (BSN) from an ACEN or CCNE-accredited program Active Indiana or Compact RN license CNOR certification required BLS and ACLS certifications required 4-6 years of related perioperative experience required (6-8 years preferred) Prior experience supervising direct reports in an OR setting is required Strong clinical knowledge and proven leadership in circulating RN roles Why Join Us? Lead a highly respected surgical and perioperative team Opportunity to influence patient care outcomes and operational performance Supportive leadership and interdisciplinary collaboration Located in Indianapolis, with access to a dynamic and growing healthcare community

Now Interviewing for a Medical Director - Integrated Primary Care in Noblesville, IN! Salary Range: $275,000- $325,000 Annually This is more than a job, it's a mission. At Aspire Indiana Health, we believe everyone deserves whole-person health care. As our Medical Director of Integrated Primary Care, you'll help shape a system that serves people regardless of income, diagnosis, or life circumstance. What makes this role special? Mission in Action - Aspire is a rare dual Federally Qualified Health Center and Community Mental Health Center, delivering fully integrated care under one roof, medical, behavioral health, addiction recovery, pharmacy, and social services; including housing, employment, and legal supports Strategic Leadership - You'll lead a talented, compassionate team across multiple clinics and work side-by-side with a forward-thinking senior team. Clinical Excellence & Innovation - We're not just treating illness, we're building Indiana's future health system, focused on equity, prevention, access, and integration. Impact Where It Matters - Serve those who are often forgotten by traditional healthcare, individuals experiencing homelessness, addiction, mental illness, poverty, and trauma. Your Voice Will Shape the Future - Influence care models, staffing strategy, performance improvement, and innovation, from social drivers of health to new site development. Competitive compensation, excellent benefits, and a supportive team, including a growing number of great medical colleagues We are seeking a leader who is energized by complexity, fueled by compassion, and eager to serve as a force for good in health care. An opportunity for a primary care doctor who is looking to develop their leadership profile, or a seasoned Medical Leader ready to bring their experience to a mission driven, community based setting in Central Indiana. Join Aspire, and help us build a health system that belongs to everyone. Education/Experience/Licensure Graduate of a medical school accredited by LCME or COCA and completion of a ACGME accredited residency in a primary care field (family medicine, internal medicine, or pediatrics) 5+ years of primary care practice experience. Experience in integrated settings, with MAT, and/or delivering primary care to Severely Mentally Ill (SMI) population preferred. Demonstrated experience in caring for underserved populations strongly preferred. 1+ years of administrative or supervisory experience in a medical department (preferably in an ambulatory care setting) strongly preferred. Must have an active, unrestricted licensed to practice medicine in the State of Indiana Must have a current Drug Enforcement Administration (DEA) certificate and State of Indiana Controlled Substance Registration (CSR) Must meet credentialing requirements of Affiliated Hospitals Must be Board Certified Must have a current BLS certification, or renew upon hire Benefits Aspire prioritizes a work culture that takes care of employees not only at work but in their personal lives as well. The following are offered to *eligible employees: Group Medical (PPO and HSA Plans) Affordable visits, labs, and prescriptions through Aspire Indiana Health clinics Health Savings Account Group Dental and Vision Plans Prescription coverage, including low copays on all covered medications through select pharmacy locations Employee Wellness Program Group Life, AD&D Insurance Long Term Disability Short Term Disability Paid-Time Off (PTO) Paid Holidays Paid Bereavement Retirement Plan with generous employer match - Up to 6% match Employee Referral Bonus Program Your Money Line Financial Wellness Program *Eligibility dependent on full time or part time status. Not all benefits are offered to part time or temporary employees. Learn more about us at Aspireindiana.org, and see our Core Values, benefits and current job listings on our Careers page. Or check out our Facebook, LinkedIn, Twitter and YouTube pages. Drug screen, TB test and extensive background checks (including Criminal History, Sex Offender Registry Search, State Central Registry Check, Education Verification, and Professional References) are required of all Aspire employees. All individuals who join Aspire are strongly encouraged to have a flu shot and required to be fully vaccinated against COVID19 prior to joining Aspire to further protect our staff and the patients we serve. We also adhere to CDC protocols including wearing masks, social distancing, and sanitizing. Aspire Indiana Health is an Equal Opportunity Employer. Not ready to apply? Connect with us for general consideration.

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 could 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 Behavioral Health Medical Director-Psychiatrist Appeals 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 strongly preferred. * Utilization Management experience. * Applied Behavior Analysis (ABA) experience. For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $250,236 to $428,976. Locations: California; Colorado; District of Columbia (Washington, DC), Illinois, New Jersey; Maryland, Minnesota, Nevada; New York. In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws. * The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law. Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ******************************************** for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

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

Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. Alternate locations may be considered. The Appeals Medical Director is responsible for the appeal reviews 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. How you make an impact: Appeal Reviews. Supports clinicians to ensure timely and consistent responses to members and providers. Provides guidance for clinical operational aspects of a program. May conduct peer-to-peer clinical case reviews with attending physicians or other ordering providers to discuss review determinations. Weekend rotation once a month on average (earning comp days) to support UM case reviews. 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. Minimum Requirements: Requires MD or DO and Board certification approved by one of the following certifying boards is required, where applicable to duties being performed, American Board of Medical Specialties (ABMS) or American Osteopathic Association (AOA). Must possess an active unrestricted medical license to practice medicine or a health profession. Unless expressly allowed by state or federal law, or regulation, must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US military base, vessel or any embassy located in or outside of the US. Minimum of 10 years of clinical experience; or any combination of education and experience, which would provide an equivalent background. For Health Solutions and Carelon organizations (including behavioral health) only, minimum of 5 years of experience providing health care is required. Additional experience may be required by State contracts or regulations if the Medical Director is filing a role required by a State agency. Preferred Qualifications: Emergency Medicine, Internal Medicine, and Family Medicine specialties preferred. 3-5 years of Utilization Management experience preferred. Indiana license or the ability to obtain an Indiana license upon hire. Job Level: Director Equivalent Workshift: 1st Shift (United States of America) 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.

Join Concentra and receive a bonus up to $50k! Monthly and Quarterly Bonus Incentives! Are you looking for a physician practice with a family environment, but with the benefits and support a large organization can provide? Where daily patient care is backed by evidenced based medicine and career options are limitless, then look no further! At Concentra, our Medical Directors spend most of their time clinically treating patients; the remaining time is focused on quality improvements and building the center business with the Center Leadership Team. This role offers an opportunity for physicians to blend their love of patient care with their management skills, working for the leader in the workplace health industry. Concentra is recognized as the nation's leading occupational health care company and one of “America's Greatest Workplaces," as noted in Newsweek. Hours: M-F 8a-5p Address: 5603 W. Raymond St. , Suites A-D (#10) Indianapolis, IN 46241 Responsibilities Responsibilities This clinic-based position provides direct patient care, leading by example, and creating an exceptional patient experience Provides leadership in healthcare management to ensure day-to-day execution of medical model collaborating with therapists and specialists to drive optimal clinical outcomes and case closure Manages clinicians, support staff, and complies with APC supervisory requirements Creates a professional and collaborative working environment Works with leaders to identify and implement changes to ensure continuous medical clinic improvement Maintains relationships with center clients and payers Works with medical clinic leadership team to manage clinical and support staffing levels Promotes, cultivates, and exemplifies Concentra values for all clinic colleagues Fosters an environment of collaboration, professionalism, patient/colleague safety, quality care, continuous improvement and reward and recognition Possesses financial awareness and provides input to clinic budget and key business metrics Why Choose Us With more than 40 years of experience, Concentra is dedicated to our mission to improve the health of America's workforce, one patient at a time. With a wide range of services and proactive approaches to care, Concentra colleagues provide exceptional service to employers and exceptional care to their employees. This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice. . Qualifications Qualifications Active and unrestricted medical license Unrestricted DEA license and dispensing license for state of jurisdiction (required prior to start date) Must be eligible to participate in Medicare Board Certification or Eligibility in an ABMS or AOA recognized specialty preferred FMCSA NRCME certification preferred or willingness to obtain Additional Data Benefits Many of our clinics offer working hours M-F, 8 to 5, no nights, no weekends, no holidays, no call Compensation package: Competitive base salary with annual merit increase opportunity Monthly Medical Director Stipend Monthly RVU Bonus Incentive Quarterly Quality Care Bonus Incentive Generous Paid Time Off package for new colleagues include: 24 days of Paid Time Off (annually, with roll-over) 5 days of Paid CME Time (annually) 6 Paid Holidays Medical Malpractice Coverage Reimbursement for dues upon approval, for the renewal of applicable licensure, certifications, memberships, etc. 401(k) with Employer Match Tuition Reimbursement opportunity Medical/Vision/Prescription/Dental Plans Life/Disability Insurance: Colleague Referral Bonus Program Opportunity to teach residents and students Training provided in Occupational Medicine Supplemental health benefits (accident, critical illness, hospital indemnity insurance) Pre-tax spending accounts (health care and dependent care FSA) Concentra accredited CME courses Occupational Health University Leadership development programs Relocation assistance (when applicable) Commuter benefits Identity theft services Colleague discount program Unmatched opportunities for advancement locally and nationally This job requires access to confidential and critical information, requiring ongoing discretion and secure information management. We will ensure that individuals with disabilities are provided reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. Please contact us to request accommodation. Concentra is an Equal Opportunity Employer, including disability/veteran #LI-LW1

We are recruiting for a Medical Director to lead a thriving SA GP hospital. The ideal candidate has a minimum of 3-5 years of experience as a Veterinarian and an interest in hospital leadership. You will be responsible for providing medical leadership for the hospital, managing and mentoring associate veterinarians, overseeing surgical and medical cases for all doctors, providing oversight and direction on medical standards, and assuring regulatory compliance relating to the practice of veterinary medicine. You will also have the opportunity to set the tone for an amazing culture where teammates are thriving! If you have been thinking about a new opportunity, this hospital might be calling your name! Competitive compensation and excellent benefits!! Confidential inquiries are welcome.

Job DescriptionMedical Director - Licensed Psychiatrist Department: Medical Salary: Competitive, based on experience Founded in 2016, Boca Recovery Center is a nationally recognized addiction treatment provider specializing in substance use disorders and co-occurring mental health conditions. With locations in Florida, New Jersey, Indiana, and Massachusetts, we deliver evidence-based, trauma-informed care in a structured and supportive environment. Our mission is to promote lasting recovery through compassionate, client-centered services. Position Overview Boca Recovery Center is seeking a Licensed Psychiatrist to serve as Medical Director for our Mental Health and residential substance use disorder treatment facility. The ideal candidate is a psychiatrist licensed to practice in the State of Indiana with significant experience in behavioral health, co-occurring disorders, and substance use disorder treatment at the inpatient detox and residential levels of care. Our Bloomington, Indiana location specializes in Mental Health, medical detoxification and residential treatment, offering a supportive setting for individuals beginning their recovery journey. Essential Duties and Responsibilities Perform and complete psychiatric evaluations and/or physical examinations for all new clients within required timelines as dictated by facility policy and Indiana State licensing standards. Ensure appropriate arrangements for follow-up care based on findings, risk factors, or identified medical/psychiatric needs. Refer clients to specialty providers when needs exceed the scope of services available within the addiction treatment center. Provide clinical leadership and oversight of detoxification treatment services, ensuring programs and resources effectively meet the needs of all clients. Develop, implement, and monitor drug-specific detoxification and withdrawal management protocols. Provide administrative and clinical oversight of all medical and psychiatric services, including pharmacological treatment. Ensure that all prescribed medications and pharmaceutical services comply with Federal and State laws and regulations, including Indiana Board of Pharmacy and Indiana Drug Enforcement Agency requirements. Designate, in writing, a qualified covering psychiatrist to act in the Medical Director's absence and ensure consistent availability of psychiatric oversight to staff and clients. Collaborate with APRNs and PAs through written and signed supervisory or collaborative agreements, including those governing prescriptive authority as required by applicable regulations. Ensure drug-utilization reviews are completed and documented per policy, including adherence to “do not use” abbreviation lists and safeguards for look-alike/sound-alike medications. Uphold and enforce policies protecting client rights and confidentiality of medical/psychiatric information. Ensure client rights and responsibilities are communicated clearly to clients, staff, and providers. Maintain processes for coordinated care internally and externally, ensuring that all medically and psychiatrically necessary services are effectively managed. Requirements Indiana licensed Psychiatrist. Extensive experience in substance use disorder treatment, specifically inpatient detoxification and withdrawal management. Strong understanding of psychiatric and medical considerations related to addiction and co-occurring disorders. Ability to maintain high standards of quality, safety, and infection control. Knowledge of regulatory, accreditation, and certification requirements relevant to addiction treatment settings. Comfort with electronic medical records and basic computer proficiency. Strong time-management skills and ability to follow established policies, guidelines, and protocols. Schedule & Commitment On-site 1 day per week (flexible scheduling available). Position does not require full-time commitment.

Greenfield, IN - Seeking Emergency Medicine Medical Director Join the Physician Partnership Where You Can Increase Your Impact Vituity's ownership model provides autonomy, local control, and a national system of support, so you can focus your attention where you want it to be - on your patients. Join the Vituity Team. Vituity is a 100% physician-owned partnership and is led by frontline physicians that are all equitable owners. As an equal and valued partner from day one, our ownership model provides you with financial transparency, a comprehensive benefits package including profit distribution, and multiple career development opportunities. Our leadership understands what your practice needs to thrive and gives you autonomy and local control so you can provide care when, where, and how your patients need it. You are backed by a best-in-class corporate healthcare team and supported by the broad peer-level expertise of 6,000 Vituity clinicians. At Vituity we've cultivated an environment where passion thrives, and success comes through shared purpose. We were founded in a culture that values team accomplishments more than individual achievements, an approach we call "culture of brilliance." Together, we leverage our strengths and experiences to make a positive impact in our local communities. We foster this through shared goals and helping our colleagues succeed, and we also understand the importance of recognition, taking the time to show appreciation and gratitude for a job well done. Vituity Locations: Vituity has opportunities at 475 sites across the country, serving 9 million patients a year. With Vituity, if you ever need to move, you can take your job with you. The Opportunity * Communicate and champion Vituity's purpose, mission, vision, values, culture of brilliance, and strategy, ensuring widespread understanding and alignment. * Assure compliance with all Vituity requirements and policies and communicate those requirements to all Vituity providers. * Monitor current and future healthcare and economic trends. Assess their potential impact on the practice and local geographic region. * Strategize and execute a comprehensive annual practice management plan that sets clear goals and objectives, continuously surpassing expectations and delivering value to patients, clients, providers, and the local community. * Spearhead the local site's administrative management team, meticulously selecting team members and aligning their responsibilities to drive the achievement of practice goals. * Demonstrate unwavering mastery of Vituity policies and fiduciary obligations, ensuring strict adherence from all providers. * Exemplify Vituity's Partnership Principles by fostering open communication and transparent decision-making, such as conducting annual reviews of administrative stipends and scheduling preferences. * Demonstrate a comprehensive understanding of hospital expectations and rigorously uphold compliance with all contract terms. * Monitor operational and quality metrics and implement Vituity initiatives and operational programs to continually improve performance. * Continuously assess and improve operational processes, leveraging technology and best practices to streamline workflows and increase efficiency. * Monitor site financial performance and identify and create new areas for growth and revenue. * Develop an expertise and understanding of the yearly budget, financial performance measures and monitoring systems, and billing and reimbursement issues / systems. * Improve patient census and billing practice statistics to optimize reimbursement for the practice. * Maintain awareness and interactions with payers such as significant IPA's, Medical Groups, Foundations, ACO's associated with the hospital / health system. * Execute efficient recruitment, onboarding, and training processes for new providers, ensuring the practice is staffed with highly qualified professionals. * Provide learning and development opportunities and mentoring to providers and staff to enhance their clinical acumen, leadership skills and overall professional growth. * Evaluate the performance of physicians and PA / NPs in compliance with Vituity policies and guidelines. * Monitor physician competencies with progressive improvement using appropriate metrics. Counsel, suspend, or remove staff from the schedule as necessary in compliance with Vituity polices / guidelines. * Actively participate in contract negotiations in conjunction with the Regional Director. * Develop, foster, and maintain productive and collaborative working relationships with hospital leadership, nursing staff and other healthcare team members. * Ensure practice is appropriately represented and demonstrates their value through leadership roles (as applicable) and/or participation with hospital management, medical staff leadership, Medical Executive, Medical Staff and other hospital committees, and within the local community. Required Experience and Competencies * Licensed physician as a Medical Doctor (M.D.) or Doctor of Osteopathic Medicine (D.O.) degree from an accredited medical school and completion of residency through an accredited residency program required. * Maintain membership and privileges on Hospital's medical staff and comply with and abide by the bylaws, rules and regulations, and the policies and procedures of Hospital's medical staff where services are being provided required. * Physician Partnership status required. * Five (5) years or more experience in a leadership role required. * Verbal and written communication skills. * Superior clinical skills. * Interpersonal and leadership skills. * Ability to motivate a team. * Project Management. * Effectively collaborate with diverse individuals and multiple locations. * Relationship building. * Technical skills. * Strong accounting and finance understanding. The Practice Hancock Regional Hospital - Greenfield, Indiana * 113-bed hospital with an 18-bed Emergency Department. * Cath lab for STEMI Mon-Fri 8am-5pm. * Annual volume of 24,000 with 62 patients per day. * Higher acuity and good pathology. * A smaller community hospital with a family-friendly atmosphere. * Great relationship with c-suite, most specialties available for consult, and EMR is user friendly. The Community * Greenfield, Indiana, is a charming city that blends small-town charm with modern conveniences, making it a wonderful place to work and call home. * Known as the birthplace of poet James Whitcomb Riley, Greenfield honors its literary heritage with the Riley Home Museum and the annual Riley Festival. * The city's historic downtown features unique shops, restaurants, and a welcoming community atmosphere. * Outdoor enthusiasts can enjoy Beckenholdt Park and the Pennsy Trail, offering opportunities for hiking, biking, and picnicking. * Seasonal weather includes snowy winters, blooming springs, warm summers, and colorful autumns, ensuring year-round recreational activities. * Greenfield's proximity to Indianapolis provides access to cultural attractions, professional sports, and diverse job opportunities. * With affordable housing, excellent schools, and a strong sense of community, Greenfield is a delightful blend of history, nature, and suburban living. Benefits & Beyond* Vituity cares about the whole you. With our comprehensive compensation and benefits package, we are mindful of what matters most, and support your needs of today and your plans for the future. * Superior Health Plan Options * Dental, Vision, HSA, life and AD&D coverage, and more * Partnership models allows a K-1 status pay structure, allowing high tax deductions * Extraordinary 401K Plan with high tax reduction and faster balance growth * Eligible to receive an Annual Profit Distribution/yearly cash bonus * EAP, travel assistance, and identify theft included * Student loan refinancing discounts * Purpose-driven culture focused on improving the lives of our patients, communities, and employees We are unified around the common purpose of transforming healthcare to improve lives and we believe everyone has a role to play in that. When we work together across sites and specialties as an integrated healthcare team, we exceed the expectations of our patients and the hospitals and clinics we work in. If you are looking to make a difference, from clinical to corporate, Vituity is the place to do it. Come grow with us. Vituity does not discriminate against any person on the basis of race, creed, color, religion, gender, sexual orientation, gender identity/expression, national origin, disability, age, genetic information (including family medical history), veteran status, marital status, pregnancy or related condition, or any other basis protected by law. Vituity is committed to complying with all applicable national, state and local laws pertaining to nondiscrimination and equal opportunity. * Visa status applicants benefits vary. Please speak to a recruiter for more details. Applicants only. No agencies please.

Job Details IN, Bunker Hill - Miami Correctional Facility - BUNKER HILL, IN Full-Time Professional Degree $290000.00 None Day Medical Physician & Advanced Practice ProviderDescription Centurion is proud to be the provider of comprehensive healthcare services to the Indiana Department of Corrections . We are currently seeking a Primary Care Physician to serve as the full-time Site Medical Director at Miami Correctional Facility located in Bunker Hill, Indiana. The Site Medical Director provides the clinical direction needed to meet the service delivery requirements of the assigned site(s). The Site Medical Director also provides direct clinical services for patients and clinical supervision for medical staff of assigned site(s) under the supervision of the Statewide Medical Director. The Site Medical Director will collaborate with Health Services Administrator at the site to ensure efficient and clinically appropriate medical services are provided and will participate in various committees to include Continuous Quality Improvement, Infection Prevention and Control and Pharmacy and Therapeutics as requested. Qualifications MD/DO BC/BE in internal medicine, family medicine or emergency medicine. Active, unrestricted IN license Active, unrestricted DEA Available Shift Day Shift Monday-Friday 4-10's or 5-8's - your choice No nights, holidays or weekends Excellent work/life balance Benefits Health, dental, vision, disability and life insurance 401(k) with company match Generous paid time off Paid holidays Flexible Spending Account Company paid malpractice insurance 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 more information contact Amy Burns, Provider Recruiter, at ************************* or ************. indmhm

Job Description Well-established rehabilitation program seeks an experienced PM&R physician to take on the role of Medical Director. Duties include collaborating w/the Program Director & the entire clinical team to provide medical direction in conformance w/the facility's policies & procedures. Includes some inpatient clinical duties. Servicing over 60K residents, the rehab hospital offers customized, intensive rehab tailored to the individual needs of those recovering from a loss of function due to an injury or illness. Financial package includes a generous salary, incentives, retirement, benefits, relo/vaca/CME, malpractice & signing bonus. Area offers easy access to Kokomo & nearby communities. For more details on this position & others we have, email us at ************************** or call ************.

**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.

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

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

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

Medical Cost AI Intelligence Director (IT Strategy & Planning Director) Location: This role requires associates to be in-office 3 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. Alternate locations may be considered if candidate resides within a commutable distance from an office. The Medical Cost AI Intelligence Director is responsible for strategy, planning and execution of technology solutions to proactively manage medical costs through the use of AI & analytics focused capabilities to drive affordable healthcare across the industry. The role will also be responsible for comprehensively looking at the provider and payer landscape to identify and drive innovative approaches for understanding medical cost trends, provider behavior, provider billing behavior, and healthcare industry operations to streamline medical costs for health plan members. How you will make an impact: * Develop and execute overall technology, inclusive of AI & analytics, strategies at the enterprise level driving alignment across various business unites to ensure enterprise financial goals & priorities are enables by technology delivery. * Partners with senior planning leaders and executive leadership to create sound multi year plans with clear planning assumptions and accurate financial insights for the technology function. * Monitors and conducts research of related technology and business trends, using data and qualitative performance measures, to advise senior management relative to IT strategy. * Synthesizes annual and multi-year plans to demonstrate tie-back to corporate and senior leadership-level strategies and goals. * Conduct external research and engage partners across multiple departments within the broader enterprise to frame up potential strategic initiatives for investment or execution support. * Use forecast models and scenario analysis to analyze performance and develop action plans to address emerging market and technological opportunities. * Researches new ventures and prospective service expansion opportunities. Create executive reports that decipher complex technical issues. Minimum Requirements: Requires an BA/BS degree in Information Technology, Computer Science or related field of study and a minimum of 10 years experience in Data Collection and Analysis, IT Consulting, IT Performance Management, Strategy or Financial Planning, Business Intelligence and Analytics, or Business Process Design; or any combination of education and experience, which would provide an equivalent background. Preferred Skills, Capabilities, and Experiences: * Healthcare experience within the provider systems, healthcare insurers , or services companies that support providers systems or healthcare insurers strongly preferred. * Experience implementing analytics solutions including use of advance AI/ML techniques strongly preferred. For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $178,200 to $291,600. Locations: California, District of Columbia (Washington DC), Illinois, New York In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the company. The company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws. * The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law. Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ******************************************** for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

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.

Location: This role requires associates to be in-office 3 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. Alternate locations may be considered. The Manager, Medical Director will serve as a clinical and strategic advisor to enterprise transformation programs spanning affordability, medical cost management, modernization, and growth initiatives. This role provides medical and clinical leadership to ensure that large-scale technology, operations, and product initiatives align with clinical best practices, regulatory requirements, and the organization's goals of affordability, quality, and innovation. The Medical Director will work closely with engineering, product, operations, and business leaders to shape transformation strategies, assess clinical and financial impacts, and guide implementation of initiatives that impact providers, members, and clients across the healthcare ecosystem. How you will make an impact: Strategic Clinical Leadership Provide clinical insight and medical guidance across multiple enterprise transformation initiatives, including: Medical Cost Management HealthOS and enterprise data platforms Real-time Decisioning & Analytics (RDA) Cost of Care / Payment Integrity Care Management / Utilization Management (CM/UM) Modernization Provider Networking & Modernization Value-Based Care and Carelon Risk models Carelon Research & Data Commercialization Client Information Insights and CDIP/Consumer Experience Advise on Teradata/SAS migration and retirement, ensuring data modernization supports clinical and operational needs. Translate complex clinical and regulatory requirements into actionable technical and operational strategies. Program & Initiative Support Partner with SVRO (Strategic Value Realization Office) and enterprise transformation leaders to assess clinical and medical cost implications of strategic initiatives. Evaluate program designs for alignment with quality, safety, and evidence-based clinical practice. Guide affordability-focused programs with a balance of cost containment, care quality, and provider/member experience. Collaboration & Influence Collaborate with engineering, analytics, and product teams to ensure platforms such as HealthOS and RDA incorporate clinical intelligence and deliver actionable insights. Advise Carelon Research and Data Commercialization teams on ethical and clinically appropriate use of healthcare data. Partner with Provider Network leaders to shape modernization strategies that drive value-based outcomes and affordability. Serve as a clinical voice in modernization of CM/UM platforms, ensuring alignment with regulatory mandates and member engagement expectations. Regulatory & Compliance Oversight Ensure compliance with clinical, accreditation, and regulatory standards across transformation programs. Support interpretation of federal/state mandates and advise on clinical implementation strategies. Minimum Requirements: Requires MD or DO and Board certification approved by one of the following certifying boards is required, where applicable to duties being performed, American Board of Medical Specialties (ABMS) or American Osteopathic Association (AOA). Must possess an active unrestricted medical license to practice medicine or a health profession. Unless expressly allowed by state or federal law, or regulation, must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US military base, vessel or any embassy located in or outside of the US. Minimum of 10 years of clinical experience: or any combination of education and experience, which would provide an equivalent background. Preferred Qualifications: 5+ years of clinical practice experience, with transition into payer, managed care, or healthcare leadership preferred. Experience advising medical cost management, utilization management, payment integrity, or provider performance programs preferred. Strong understanding of healthcare data systems (claims, EHR, analytics platforms) and payer operations preferred. Proven ability to influence cross-functional teams and guide complex, enterprise-level initiatives. Prior leadership in a payer, health plan, or healthcare innovation organization preferred. Familiarity with enterprise platforms such as Teradata, SAS, or cloud-based data ecosystems. Experience in value-based care, population health, and care management program design preferred. Understanding research and data commercialization within healthcare. Ability to communicate effectively with technical, clinical, and executive stakeholders. For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $291,900 to $500,400 Locations: California, Colorado, District of Columbia (Washington, DC) Illinois, New Jersey, New York, Washington State 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 Workshift: 1st Shift (United States of America) 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.