Medical director jobs in Santa Fe, NM - 154 jobs

**Become a part of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement to make determinations whether requested services, requested level of care, and/or requested site of service should be authorized. All work occurs within a context of regulatory compliance, and work is assisted by diverse resources, which may include national clinical guidelines, CMS and state policies and determinations, clinical reference materials, internal teaching conferences, and other reference sources. Medical Directors will learn Medicare, Medicare Advantage, and Medicaid 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, and possible participation in care management. May occasionally participate in discussions with external physicians by phone to gather additional clinical information or discuss determinations which may require conflict resolution skills. Some roles include an overview of coding practices and clinical documentation, dispute, 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 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. Medical Directors support Humana values throughout all activities. **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 and state Medicaid requirements, Humana policies, clinical standards, and (in some cases) contracts. The ideal candidate supports and collaborates with other team members, other departments, and Humana colleagues. 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. Supports the assigned work with respect to market-wide objectives and community relations as directed. **Required Qualifications** + MD or DO degree + 5+ years of direct clinical patient care experience post residency or fellowship, which preferably includes some experience in an inpatient environment and/or related to care of a Medicare type population (disabled or >65 years of age). + Current and ongoing Board Certification an approved ABMS Medical Specialty + A current and unrestricted license in at least one jurisdiction and willing to obtain additional license(s), if required. + No current sanction from Federal or State Governmental organizations, and able to pass credentialing requirements. + Excellent verbal and written communication skills. + Evidence of analytic and interpretation skills, with prior experience participating in teams focusing on quality management, utilization management, 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. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial health insurance. + Experience with national guidelines such as MCG or InterQual + Internal Medicine, Family Practice, Geriatrics, Hospitalist, Emergency Medicine clinical specialists + Advanced degree such as an MBA, MHA, MPH + Exposure to Public Health, Population Health, analytics, and use of business metrics. + Experience working with Case managers or Care managers on complex case management, including familiarity with social determinants of health. + The curiosity to learn, the flexibility to adapt and the courage to innovate **Additional Information** Typically reports to a Lead Medical Director, depending on the line of business. The Medical Director conducts Utilization Management or clinical validation of the care received by members in an assigned line of business, member population, or condition type. May also engage in dispute, grievance, and appeals reviews. May participate on project teams or organizational committees. \#physiciancareers Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. **Scheduled Weekly Hours** 40 **Pay Range** The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $223,800 - $313,100 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. **Description of Benefits** Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. Application Deadline: 02-28-2026 **About us** Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. **Equal Opportunity Employer** It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our ***************************************************************************

Sumitomo Pharma Co., Ltd. is a global pharmaceutical company based in Japan with key operations in the U.S. (Sumitomo Pharma America, Inc.), Canada (Sumitomo Pharma Canada, Inc.) and Europe (Sumitomo Pharma Switzerland GmbH) focused on addressing patient needs in oncology, urology, women's health, rare diseases, psychiatry & neurology, and cell & gene therapies. With several marketed products in the U.S., Canada, and Europe, and a diverse pipeline of early- to late-stage assets, we aim to accelerate discovery, research, and development to bring novel therapies to patients sooner. For more information on SMPA, visit our website ********************************** (***************************************************************************************************************************************************** or follow us on LinkedIn (https://c212.net/c/link/?t=0&l=en&o=4190475-1&h=**********&u=https%3A%2F%2Fwww.linkedin.com%2Fcompany%2Fsumitomo-pharma-america%2F&a=LinkedIn) . **Job Overview** We are currently seeking a dynamic, highly motivated, and experienced individual for the position of Senior Medical Director, Clinical Research (Ophthalmology) to join our R&D Organization. This individual will contribute to the design and execution of clinical development plan(s) for assigned asset(s) and serve as the Clinical Research Lead for stem cell program within the Ophthalmology therapeutic area. **Job Duties and Responsibilities** + Responsible for and lead all activities related to clinical study design from clinical study concept to clinical study protocol for both early- and late-stage programs + Leads or joins multi-disciplinary, multi-regional, matrix team through highly complex decisions + Leads and drives strategy for clinical studies for assigned asset(s) within the Ophthalmology therapeutic area + Provides oversight of clinical trial conduct, interacting with CROs, medical monitors, and vendors as required, and working with the safety group to ensure adequacy of safety monitoring and reporting + Provide clinical input for and participate in study set up and design including data collection tools, data analysis, eCRF design, edit checks, vendor database design plans, etc. + Study-level, site-level and subject-level data review and interpretation, including documentation and summarization of findings + Serve as the internal medical monitoring for clinical trials + Review and provide input for the design of the statistical analysis plans, TLFs, and the clinical data output + Contributes to interpretation of clinical trial results and the writing of clinical study reports + Contributes to the preparation of Investigator Brochures, annual reports, data collection systems and final reports in compliance with appropriate scientific/regulatory/medical standards + Contributes to developing clinical components of BLA/NDAs, sNDAs, MAAs and other regulatory filing documents + Contributes to company responses to health authorities and ethics committees for ongoing clinical programs to ensure timely registration and initiation of trials globally + Contributes to the development of presentation materials for investigator meetings, health authority meetings, scientific advisory board meetings, and national and international scientific meetings + Serve as the subject matter expert for ophthalmology, representing Clinical Research to both internal and external customers + 20% domestic and international travel **Key Core Competencies** + Knowledge and understanding of FDA, GCP, and ICH regulations and guidance + Thorough and up-to-date knowledge of therapeutic area including trends, advances, understanding of currently available therapies and competitive clinical landscape + Experience in conducting global clinical trials in both early- and late-stage clinical development, especially protocol development and trial initiation + Experience in regulatory submissions in US; preferred experience in Europe and Japan + Demonstrated ability to set clear priorities, lead, influence and build consensus in a multi-disciplined team environment + Strong team leadership skills and ability to motivate large multi-functional teams + Ability to effectively synthesize, interpret and present scientific information to both internal stakeholders and external medical community + High degree of organizational awareness, ability to connect the dots to understand all the interdependencies and big picture + Excellent interpersonal and communication skills with the ability to balance multiple tasks and work within a multi-disciplinary team **Education and Experience** + MD (or international equivalent) + Board certified or board eligible in ophthalmology + Fellowship training in vitreoretinal surgery (preferred) or retina + A minimum of 5 years' experience in the pharmaceutical industry, with experience as Clinical Research Lead in Ophthalmology therapeutic area + Experience in regenerative cell medicine or gene therapy preferred + Prior experience working with Japan organizations is preferred The base salary range for this role is $284,320 to $355,400. Base salary is part of our total rewards package which also includes the opportunity for merit-based salary increases, short incentive plan participation, eligibility for our 401(k) plan, medical, dental, vision, life and disability insurances and leaves provided in line with your work state. Our robust time-off policy includes flexible paid time off, 11 paid holidays plus additional time off for a shut-down period during the last week of December, 80 hours of paid sick time upon hire and each year thereafter. Total compensation, including base salary to be offered, will depend on elements unique to each candidate, including candidate experience, skills, education and other factors permitted by law. Disclaimer: The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified. All personnel may be required to perform duties outside of their normal responsibilities from time to time, as needed. **Confidential Data** : All information (written, verbal, electronic, etc.) that an employee encounters is considered confidential. **Compliance** : Achieve and maintain Compliance with all applicable regulatory, legal and operational rules and procedures, by ensuring that all plans and activities for and on behalf of Sumitomo Pharma America (SMPA) and affiliates are carried out with the "best" industry practices and the highest ethical standards. It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability. **Mental/Physical Requirements** : Fast paced environment handling multiple demands. Must be able to exercise appropriate judgment as necessary. Requires a high level of initiative and independence. Excellent written and oral communication skills required. Requires ability to use a personal computer for extended periods of time. **Sumitomo Pharma America (SMPA)** **is an Equal Employment Opportunity (EEO) employer** Qualified applicants will receive consideration for employment without regard to race; color; creed; religion; national origin; age; ancestry; nationality; marital, domestic partnership or civil union status; sex, gender; affectional or sexual orientation; disability; veteran or military status or liability for military status; domestic violence victim status; atypical cellular or blood trait; genetic information (including the refusal to submit to genetic testing) or any other characteristic protected by law. Sumitomo Pharma Co., Ltd., is a global pharmaceutical company based in Japan with operations in the U.S. (Sumitomo Pharma America, Inc.), focused on addressing patient needs in oncology, urology, women's health, rare diseases, cell & gene therapies and CNS. With several marketed products and a diverse pipeline of early- to late-stage investigational assets, we aim to accelerate discovery, research, and development to bring novel therapies to patients sooner. For more information on SMPA, visit our website ********************************** or follow us on LinkedIn. Sumitomo Pharma America (SMPA) endeavors to make its application process accessible to all. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact SMPA at ********************************************** This contact information is for accommodation requests only and cannot be used to inquire about the status of applications. At Sumitomo Pharma America, our work is guided by the Sumitomo Pharma mission, vision and values, which tie closely to our company's cultural pillars. **Our** **Mission** _To broadly contribute to society through value creation based on innovative research and development activities for the betterment of healthcare and fuller lives of people_ _worldwide_ **Our** **Vision** _For Longer and Healthier Lives, we unlock the future with cutting edge technology and_ _ideas_

Sub-Acute, Long-Term Care is a sector of healthcare exploding with potential and work-life balance flexibility (no weekends or on call)! We are seeking a FFS Attending Physician/Medical Director for our Casa Real Center located in Albuquerque, NM, with potential float to nearby centers. This is a Dual Role Attending Physician/Medical Director. It is clinical in nature. Must be BC/BE Internal Medicine or Family Medicine with LTC Experience. AlignMed Partners is a national medical group dedicated to improving health outcomes among residents of skilled nursing and senior living facilities. Our physicians, nurse practitioners (NPs) and physician assistants (PAs) are supported by a clinical leadership team with a decades-long track record of excellence in post-acute and long-term care. At AlignMed, we believe in a better quality of life for all. Our mission is to elevate healthcare outcomes for our patients, providers, and partners. In living out our mission, we embrace the following pillars in our day-to-day operations. Responsibilities The Medical Director partners with the Regional Medical Director to promote the delivery of clinical services in a manner that fulfills the AlignMed Partners mission of achieving the highest levels of clinical quality, efficiency, and outcomes. This is accomplished by coordinating with Centers, Regional Management and AlignMed Partners to oversee the implementation, utilization, and outcomes measurement of AlignMed Partners Clinical Programs. The Medical Director is dually accountable to the Center Administrator and the AlignMed Partners Regional Medical Director for clinical care within the Center, accountable to the Center Administrator for delivery of clinical services as stipulated in the Medical Director Agreement, and accountable to the Regional Medical Director for the quality and efficiency of clinical services and outcomes within the Center. Medical Directors partner with the Center Administrator and Director of Nursing, to achieve the highest levels of Center performance in quality, safety, and efficiency. Our Medical Directors share accountability for Center success in the evolving environment of narrow referral networks and value-based reimbursement, providing effective and proactive. Qualifications M.D. or D.O. required. Board Certified in Internal Medicine or Family Medicine preferred, with maintenance of certification Geriatrics specialization is desirable. Certified Medical Director (CMD) through AMDA is desirable. Benefits *No-cap Incentive Compensation Program *Relocation bonus for eligible candidates. Eligibility will be determined by distance, experience, and priority *Health, Dental, and Vision plans *100% employer-paid ArmadaCare Plan: supplemental plan which provides reimbursement for many out-of-pocket medical, wellness, and pharmacy expenses, with an eight thousand max reimbursement for designated expenses and tiered pharmacy reimbursements for single and family plans *Paid Time Off, 6 Paid Holidays, Paid Sick Time, Bereavement Leave *Continuing Medical Education time off and reimbursement allotments *Reimbursement for primary state licensing renewal costs and primary board recertification fees *Reimbursement for DEA/CDS renewal fees *Malpractice insurance policy *401(k) plan and company-paid group life insurance Restrictions apply based on collective bargaining agreements, applicable state law and factors such as pay classification, job grade, location, and length of service. Posted Salary Range USD $200,000.00 - USD $300,000.00 /Yr. Genesis HealthCare, Inc. and all affiliated entities (collectively "Genesis") has a strong commitment to diversity that is fully supported and practiced by our officers and leadership team. Genesis provides equal employment opportunities to all employees and applicants for employment without regard to actual or perceived race, color, religion, gender, gender expression, gender identity, sex, sexual orientation, HIV status, national origin, age, disability, marital status, pregnancy, ancestry, citizenship, genetic information, amnesty, military status or status as protected veterans, or any other legally protected characteristic. Genesis is an Affirmative Action and Equal Opportunity Employer and our goal is to foster an inclusive and accessible workplace free from discrimination and harassment where everyone has equal opportunities to succeed.

JOB DESCRIPTION Job SummaryProvides medical oversight and expertise related to behavioral health and chemical dependency services, and assists with implementation of integrated behavioral health care programs within specific markets/regions. Contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties - Provides behavioral health oversight and clinical leadership for health plan and/or market specific utilization management and care management behavioral health programs and chemical dependency services - working closely with regional medical directors to standardize behavioral health utilization management policies and procedures to improve quality outcomes and decrease costs. - Facilitates behavioral health-related regional medical necessity reviews and cross coverage. - Standardizes behavioral health-related utilization management, quality, and financial goals across all lines of businesses. - Responds to behavioral health-related requests for proposal (RFP) sections and reviews behavioral health portions of state contracts. - Assists behavioral health medical director lead trainers in the development of enterprise-wide education on psychiatric diagnoses and treatment. - Provides second level behavioral health clinical reviews, peer reviews and appeals. - Supports behavioral health committees for quality compliance. - Implements behavioral health specific clinical practice guidelines and medical necessity review criteria. - Tracks all clinical programs for behavioral health quality compliance with National Committee for Quality Assurance (NCQA) and Centers for Medicare and Medicaid Services (CMS). - Assists with the recruitment and orientation of new psychiatric medical directors. - Ensures all behavioral health programs and policies are in line with industry standards and best practices. - Assists with new program implementation and supports for health plan in-source behavioral health services. Required Qualifications - At least 3 of relevant experience, including 2 years of medical practice experience in psychiatry/behavioral health, or equivalent combination of relevant education and experience. - Doctor of Medicine (MD) or Doctor of Osteopathy (DO). License must be active and unrestricted in state of practice. - Board Certification in Psychiatry. - Working knowledge of applicable national, state, and local laws and regulatory requirements affecting medical and clinical staff. - Ability to work cross-collaboratively within a highly matrixed organization. - Strong organizational and time-management skills. - Ability to multi-task and meet deadlines. - Attention to detail- available to work PST zone. - Critical-thinking and active listening skills. - Decision-making and problem-solving skills. - Strong verbal and written communication skills. - Microsoft Office suite/applicable software program(s) proficiency, and ability to learn new programs. Preferred Qualifications - Experience with utilization/quality program management. - Managed care experience. - Peer review experience. - Certified Professional in Healthcare Management (CPHM), Certified Professional in Health Care Quality (CPHQ), Commission for Case Manager Certification (CCMC), Case Management Society of America (CMSA) or other health care or management certification. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $186,201.39 - $363,093 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and most current clinical standards. The incumbent reviews escalated cases electronically and using Medical Policy criteria sets to evaluate the medical necessity and appropriateness of the requested treatment of service. Depending on the nature of the case, telephonic peer to peer discussions may be required. The incumbent ensures compliance to NCQA, URAC, CMS, DOH, and DOL regulations at all times. In addition to utilization review, the incumbent participates as the physician member of the multidisciplinary team for case and disease management. They will advise the multidisciplinary team on cases, particularly high-risk cases, through the team structure. Additionally, the incumbent may be assigned special projects to help support and improve the care of our members **ESSENTIAL RESPONSIBILITIES** + Conduct electronic review of escalated cases against medical policy criteria, which may include telephonic peer to peer discussions, to determine medical necessity and appropriateness. Complete initial determination of cases, review of appeals and grievances, and other reviews as assigned. Compose clear and concise rationales for member and provider determination notifications all while adhering to required compliance standards (NCQA, URAC, CMS, DOH, and DOL regulations, etc.). Ensure that all aspects of the medical management process are consistent with community standards of care. + Participate as a member of the CMDM multidisciplinary team. Attend huddles and grand rounds. Advise multidisciplinary team on cases that require physician expertise. + Participate in protocol and guidelines development to ensure consistency in the review process. + Actively manage projects and/or participate on project teams that require a physician subject matter expert. + Other duties as assigned. **EDUCATION** **Required** + Medical Doctor (MD) or Doctor of Osteopathic Medicine (DO) **Substitutions** + None **Preferred** + Master's Degree in Business Administration/Management or Public Health **EXPERIENCE** **Required** + 5 years in Clinical, Direct Patient care (hospital, outpatient, or private practice) **Preferred** + 1 year in Medical Management in a Health Insurance Plan; strong knowledge of managed care industry **LICENSES AND CERTIFICATION** **Required** + Medical Doctor or Doctor of Osteopathic Medicine (DO) + Awarded Board Certification at least once in specialty recognized by the American Board of Medical Specialties or the American Osteopathic Association Specialty Certifying Boards + Active medical state licensure required. Additional specific state licensure(s) may be required based on business need. **Preferred** + None **SKILLS** + Critical Thinking + Case Management + Customer Service + Oral & Written Communication Skills + Collaboration + Listening + Telephone Skills + General Computer Skills + Clinical Software + Managed Care **Language (Other than English)** None **Travel Required** 0% - 25% **PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS** Position Type Office-Based Teaches / trains others regularly Occasionally Travel regularly from the office to various work sites or from site-to-site Rarely Works primarily out-of-the office selling products/services (sales employees) Never Physical work site required No Lifting: up to 10 pounds Constantly Lifting: 10 to 25 pounds Rarely Lifting: 25 to 50 pounds Rarely **_Disclaimer:_** _The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job._ **_Compliance Requirement_** _: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies._ _As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company's Handbook of Privacy Policies and Practices and Information Security Policy._ _Furthermore, it is every employee's responsibility to comply with the company's Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements._ **Pay Range Minimum:** $170,000.00 **Pay Range Maximum:** $352,500.00 _Base pay is determined by a variety of factors including a candidate's qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets._ Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law. We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below. For accommodation requests, please contact HR Services Online at ***************************** California Consumer Privacy Act Employees, Contractors, and Applicants Notice Req ID: J272806

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

Animal Clinic of Los Alamosis looking for a full\-time Medical Director that can join our team and help us grow as well as have some fun in the process. Requirements A strong leader who wants to build a great medical team. · 3 or more years of experience as a veterinarian. · Excellent interpersonal skills, strong written and oral communication skills. · Sound medical reasoning skills and strong medical ethics. Doctor of Veterinary Medicine (DVM \/ VMD) or equivalent degree required. · State Veterinary Board License and must be in good standing for the state in which they intend to be hired, prior to their start date. · Active DEA license or DEA licensure eligible. Benefits We provide benefits spread comprehensively across your mental, physical, emotional, and financial wellbeing designed to meet your needs as a unique individual. Some key benefits include: · Medical Director Stipend · Paid time off including 8\-weeks of full\-pay parental leave, bereavement to grieve both humans and pets, and time off for new pet adoptions. · Pet perks include free exams, discounts on products and services, and more at all Thrive Pet Healthcare locations. · Generously subsidised backup and ongoing care support for children, adults, and pets · Mental health benefits including coaching and therapy sessions. · Continuing education support through free courses, CE credits and paid time off to complete. "}}],"is Mobile":false,"iframe":"true","job Type":"Full time","apply Name":"Apply Now","zsoid":"691038520","FontFamily":"Verdana, Geneva, sans\-serif","job OtherDetails":[{"field Label":"Industry","uitype":2,"value":"Health Care"},{"field Label":"State\/Province","uitype":1,"value":"New Mexico"},{"field Label":"City","uitype":1,"value":"Los Alamos"},{"field Label":"Zip\/Postal Code","uitype":1,"value":"87544"},{"field Label":"Full Address","uitype":116,"value":", Los Alamos, New Mexico, 87544, United States"}],"header Name":"Medical Director","widget Id":"532458000000072311","awli IntegId":"urn:li:organization:11861693","is JobBoard":"false","user Id":"532458000001126059","attach Arr":[],"awli ApiKey":"78sym2tke8uxc8","custom Template":"3","awli HashKey":"b09ba91a910668e603d348b22741701ea03df48d59bb392653baa4f35691d3f84f882ee7adf5f2f3df223e4bfc8ac2840cba1ee5b11c62dfa44576e6f56ab4d3","is CandidateLoginEnabled":false,"job Id":"532458000019614305","FontSize":"12","google IndexUrl":"https:\/\/getavetstaffing.zohorecruit.com\/recruit\/ViewJob.na?digest=VQaOU3atG9jndOZq3r@lLN6jSx58qKxdtuBFBgWiPLo\-&embedsource=Google","location":"Los Alamos","embedsource":"CareerSite","indeed CallBackUrl":"https:\/\/recruit.zoho.com\/recruit\/JBApplyAuth.do","logo Id":"et0kqf0402136da8a48159a7c64912765b91e"}

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

Make Every Day Count - Serve Veterans, Travel with Purpose, and Grow Your Career on Your Terms! If you're a Family Medicine Physician who thrives on variety, flexibility, and mission-driven work, this role is built for you. At Primary Care Solutions (PCS), we deliver high-quality primary care to Veterans through Community-Based Outpatient Clinics (CBOCs) nationwide. We're a Veteran-led, clinician-managed organization that prioritizes provider support and Veteran satisfaction. Now, we're hiring a Medical Director Family Medicine-a unique opportunity to care for Veterans at our community-based outpatient clinic. H1B visa candidates are encouraged to apply Why You'll Love This Role * Mission-Driven Work: Serve America's Veterans-the most deserving patient population in the country * Flexibility + Stability: Predictable weekday hours (Mon-Fri, 8:00 am-4:30 pm local clinic time) * Career Growth: Gain broad clinical exposure and become a key player in our Veteran care model Benefits * 31 total paid days off: 10 PTO Days + 11 Federal Holidays + 10 Personal Days * Medical, Dental, Vision, and Prescription Plans * 401(k) with company match * Paid Malpractice Coverage * Annual CME Stipend + CME Paid Time Off * Company-paid Life and Disability Insurance * Colleague Referral Bonus Program * Dedicated admin time for documentation and care coordination What You'll Do * Primarily a direct clinical care role, diagnosis, and treatment of veterans * Oversee the clinical care given to veterans enrolled in the clinic * Medical resource for care delivery * Achieve and maintain excellent clinical outcomes through periodic chart reviews, direct observation, and by abiding by VA guidelines. * Develop and maintain a positive, collaborative and working relationship with our VA partners * Support patient enrollment and retention by providing guidance, when necessary, regarding scheduling, follow-up visits, or nurse visits. Who We're Looking For * Doctor of Medicine or Osteopathic Medicine Degree (MD/DO) * Board-certified in family practice or internal medicine * 2 years of clinical medical practice in primary care preferred * Active state license and DEA in state of practice * Current certification in American Heart Association Basic Cardiac Life Support (to be renewed annually) * Ability to provide clinical leadership * Maintain a positive clinic culture by displaying an enthusiastic and encouraging demeanor * Excellent computer skills; VA experience a plus - CPRS/VISTA GUI! If you're looking for a role with purpose, paid travel, work-life balance, and a supportive team -you've found it. Apply today and start making a difference in more places than one. As a Federal Contractor Primary Care Solutions (PCS) prohibits discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities. We prohibit discrimination against all individuals based on their race, color, religion, sex, sexual orientation, gender identity, and national origin. PCS takes affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status.

The Medical Director, Rare Disease is a critical role responsible for shaping the strategic processes and planning for assets in across phases of development within the Rare Disease portfolio. This position manages the unique challenge of establishing an emerging portfolio, incorporating newly acquired assets, which requires significant scientific and strategic agility and a strong ability to balance competing priorities. This position reports directly to the Rare Disease Medical Business Unit (BU) Lead. **** **Key Responsibilities Include:** **Medical Strategy & Narrative** + Provide key medical input into the initial development of the Target Reimbursable Product Profile as well as early development plans ensuring scientific consistency and alignment across functions (e.g., R&D, Clinical, Global Medical Affairs) + Provide high-quality scientific/clinical input and review of early asset plans, ensuring content aligns with the overarching Medical Narrative + Lead and nurture strategic partnerships with stakeholders by ensuring clear, consistent communication and aligning initiatives with partner priorities to strengthen collaboration and drive shared success in the rare disease space + Serve as a primary scientific resource, providing guidance on the disease state and mechanism of action for the Rare Disease portfolio helping to translate science into value for patients and stakeholders + Lead the Strategy and Tactical Planning Process, identifying critical data needs for the emerging portfolio **Evidence Generation Process** + Oversee the Medical Evidence Generation Process in partnership with GIE&I, translating strategic data gaps into clear research priorities and providing expert input into the design and feasibility of innovative clinical trials and data generation initiatives + Support the planning and execution of Medical Affairs evidence generation activities relevant to the Rare Disease portfolio **External Stakeholder Engagement** + Identify and engage a wide variety of stakeholders, including KOL experts and patient advocacy groups to support collection, curation and communication of clinical Medical and methodological insights to inform understanding of unmet medical needs, emerging standard of care and development opportunities + Develop Key Intelligence Topics & Questions (KITs/KIQs) for relevant assets, serving as the blueprint for insight collection from Key Opinion Leaders + Lead the strategic planning, content development, and successful facilitation of consulting activities including Advisory Boards, ensuring objectives align with data gap analyses and asset/portfolio strategy + Lead scientific exchange with key opinion leaders (KOLs) to gather insights and validate development hypotheses + Support the development of scientific publications, abstracts, and presentations related to the Rare Disease portfolio **Cross-functional Integration & Planning** + Collaborate within the Rare Disease Medical Business Unit with the Rare Disease Medical Communications and Field Medical Affairs sub-teams + Partner with and serve as a scientific and clinical resource for cross-functional colleagues including Clinical Development, Global Integrated Evidence & Innovation, Regulatory and Global Marketing and Market Access + Support indication prioritization and portfolio planning for early assets + Manage assigned Rare Disease medical program budgets in partnership with the Rare Disease Medical BU lead, ensuring accurate forecasting, responsible resource utilization, and compliance with internal policies and external regulations + Consider technology and AI to support workflow improvement **Qualifications** **Education and Experience:** + Advanced scientific degree is required (PharmD, MD, PhD, or equivalent) with extensive expertise in Rare Disease + Minimum of 5+ years of relevant experience in the pharmaceutical industry, with strong preference for experience in Clinical Development, Research, or Medical Affairs + Experience supporting BD evaluations for potential acquisitions + Experience contributing to the integration and strategic planning for newly acquired or in-licensed assets + Proven experience managing Evidence Generation processes and executing scientific Advisory Boards **Skills and Competencies:** + Strong leadership presence and ability to present to executive leadership team + Skilled in cultivating strong relationships with global medical partners through proactive communication and strategic prioritization + Motivated and solution-oriented with the ability to work collaboratively across the organization, particularly with R&D and Clinical teams + Strategic agility required to build and adapt scientific strategy for an emerging portfolio + Excellent communication and interpersonal skills, including experience presenting complex development strategies to large internal groups and engaging a limited number of highly specialized external experts + Full understanding of rules and regulations in pharma, with the ability to apply knowledge of guidelines and regulations to early-stage Medical Affairs activities + Ability to work in a fast-paced, dynamic environment, with a proactive and problem-solving mindset + Strong understanding of drug development processes, especially early-stage development + Openness to travel up to ~25% for 3 - 6 conferences in US and globally **Competencies** **Accountability for Results -** Stay focused on key strategic objectives, be accountable for high standards of performance, and take an active role in leading change. **Strategic Thinking & Problem Solving -** Make decisions considering the long-term impact to customers, patients, employees, and the business. **Patient & Customer Centricity -** Maintain an ongoing focus on the needs of our customers and/or key stakeholders. **Impactful Communication -** Communicate with logic, clarity, and respect. Influence at all levels to achieve the best results for Otsuka. **Respectful Collaboration -** Seek and value others' perspectives and strive for diverse partnerships to enhance work toward common goals. **Empowered Development -** Play an active role in professional development as a business imperative. Minimum $209,599.00 - Maximum $313,375.00, plus incentive opportunity: The range shown represents a typical pay range or starting pay for individuals who are hired in the role to perform in the United States. Other elements may be used to determine actual pay such as the candidate's job experience, specific skills, and comparison to internal incumbents currently in role. Typically, actual pay will be positioned within the established range, rather than at its minimum or maximum. This information is provided to applicants in accordance with states and local laws. **Application Deadline** : This will be posted for a minimum of 5 business days. **Company benefits:** Comprehensive medical, dental, vision, prescription drug coverage, company provided basic life, accidental death & dismemberment, short-term and long-term disability insurance, tuition reimbursement, student loan assistance, a generous 401(k) match, flexible time off, paid holidays, and paid leave programs as well as other company provided benefits. Come discover more about Otsuka and our benefit offerings; ********************************************* . **Disclaimer:** This job description is intended to describe the general nature and level of the work being performed by the people assigned to this position. It is not intended to include every job duty and responsibility specific to the position. Otsuka reserves the right to amend and change responsibilities to meet business and organizational needs as necessary. Otsuka is an equal opportunity employer. All qualified applicants are encouraged to apply and will be given consideration for employment without regard to race, color, sex, gender identity or gender expression, sexual orientation, age, disability, religion, national origin, veteran status, marital status, or any other legally protected characteristic. If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation, if you are unable or limited in your ability to apply to this job opening as a result of your disability. You can request reasonable accommodations by contacting Accommodation Request (EEAccommodations@otsuka-us.com) . **Statement Regarding Job Recruiting Fraud Scams** At Otsuka we take security and protection of your personal information very seriously. Please be aware individuals may approach you and falsely present themselves as our employees or representatives. They may use this false pretense to try to gain access to your personal information or acquire money from you by offering fictitious employment opportunities purportedly on our behalf. Please understand, Otsuka will **never** ask for financial information of any kind or for payment of money during the job application process. We do not require any financial, credit card or bank account information and/or any payment of any kind to be considered for employment. We will also not offer you money to buy equipment, software, or for any other purpose during the job application process. If you are being asked to pay or offered money for equipment fees or some other application processing fee, even if claimed you will be reimbursed, this is not Otsuka. These claims are fraudulent and you are strongly advised to exercise caution when you receive such an offer of employment. Otsuka will also never ask you to download a third-party application in order to communicate about a legitimate job opportunity. Scammers may also send offers or claims from a fake email address or from Yahoo, Gmail, Hotmail, etc, and not from an official Otsuka email address. Please take extra caution while examining such an email address, as the scammers may misspell an official Otsuka email address and use a slightly modified version duplicating letters. To ensure that you are communicating about a legitimate job opportunity at Otsuka, please only deal directly with Otsuka through its official Otsuka Career website ******************************************************* . Otsuka will not be held liable or responsible for any claims, losses, damages or expenses resulting from job recruiting scams. If you suspect a position is fraudulent, please contact Otsuka's call center at: ************. If you believe you are the victim of fraud resulting from a job recruiting scam, please contact the FBI through the Internet Crime Complaint Center at: ******************* , or your local authorities. Otsuka America Pharmaceutical Inc., Otsuka Pharmaceutical Development & Commercialization, Inc., and Otsuka Precision Health, Inc. ("Otsuka") does not accept unsolicited assistance from search firms for employment opportunities. All CVs/resumes submitted by search firms to any Otsuka employee directly or through Otsuka's application portal without a valid written search agreement in place for the position will be considered Otsuka's sole property. No fee will be paid if a candidate is hired by Otsuka as a result of an agency referral where no pre-existing agreement is in place. Where agency agreements are in place, introductions are position specific. Please, no phone calls or emails.

The Breast USDMA is a US- based position within our Research & Development Division, US Medical Affairs. This position strategically drives scientific excellence across in-line business and our Company's One Pipeline while optimizing field readiness across the USMA strategic pillars: 1.) Scientific Exchange 2.) Company Trials 3.) Investigator-Sponsored Programs 4.) Congresses 5.) Insights The USDMA is an experienced therapeutic area (TA) leader and subject matter expert (SME) with relevant medical affairs and field medical experience. This role is also responsible for driving execution of scientific and medical affairs plans for assigned Therapy Areas within their region, engaging with regional cross-functional teams, and providing US input to the relevant cross-functional team meetings, e.g., US MAT, PAT, MT and V&I Plans. As a core member (or co-lead) of the US Medical Affairs Team (MAT), the USDMA collaborates with the Global Breast TA team and cross-functional partners to enable US regional implementation of Value & Implementation (V&I) Planning by: 1) Integrating local insights into Global Scientific Value Content (GSVC) and Center of Scientific Exchange Excellence (CSEE) plans 2) Facilitating local adoption of GSVC and CSEE initiatives 3) Leading development and execution of aligned local training programs 4) Evaluating training effectiveness and application in the field. **Primary Responsibilities** + In collaboration with USMA Executive Director (ED) and Health Systems PASL, conduct development and implementation of regional strategies aligned with headquarters V&I goals including defining a prioritized USMA Field strategy and implementation goals. + Contribute to the integrated US Country Medical Affairs Plan (CMAP), including the US Field Medical Plan (FMP)/Field Engagement Plan (FEP) and field training plan for assigned TA as a member of the USMA TA Leadership Team + Identifies and prioritizes US field resources, training needs and activities; and in collaboration with GMVC, ensures strategically aligned content and training and any other needed adult learning activities across the portfolio. This would also include the pull-through of pre- and post-congress regional training and content. + Develop a strategic and comprehensive scientific engagement plan and ensure scientific exchange aligns with the global scientific communications platform. + Ensure insights from advisory boards and field medical activities are actioned with relevant stakeholders, aligned with Country Medical Affairs priorities, and monitored for trends impacting future strategy. + In collaboration with relevant USMA stakeholders (e.g. HS PASL), organize expert input events (e.g., advisory boards, forums) with contracted Scientific Leaders and key stakeholders to address new indication implementation and/or emerging science. + Manage programs (i.e. patient support, education, risk management) as needed for appropriate and safe utilization of company medicines. + Partner with GSVC, CSEE, US Global Clinical Trial Organization (GCTO), Global Medical and Scientific Affairs (GMSA) TA leads, and internal/external SMEs to orchestrate and deliver regional training as needed. + Participate in bi-directional information exchange and sharing of best practices across USMA roles and teams, including Health Systems. + Collaborate with the USMA Field Medical Alignment Director (FMAD) to ensure consistent standards, processes, and harmonization for training activities (e.g., clinical immersions, verbalizations, journal clubs). + Provide input into strategic congress priorities and participate in planning at key scientific congresses. + Continuously monitor healthcare environment and emerging trends to optimize CMAPs and field execution plans. **Additional Responsibilities (as applicable)** + Serve as a point of contact for development and maintenance of US new-hire scientific foundational onboarding in collaboration with leadership and SMEs. + Work with USMA Leadership and GMVC stakeholders to ensure consistent verbalization processes for new hires and tenured RMSDs regarding new data, indications, and disease areas. + Providesupport for the Investigator Studies Program (ISP) for assigned TA, including Areas of Interest consultation, dissemination, data highlights, training, and scientific review as requested by the GMSA ED **Required Qualifications, Skills & Experience** **Minimum** + An advanced degree (e.g., MD, PhD, PharmD) relevant to the TA-specific disease area and recognized medical expertise in the breast cancer. + A minimum of 5 years of medical affairs experience or equivalent clinical/research experience + A minimum of 3 years of working in breast cancer (clinical, research, or pharmaceutical environment) or within a highly relevant TA with demonstrated scientific acumen. + Proven ability in Strategic Decision Making & Planning, including helping the US Executive Director prioritize initiatives across the portfolio. + Demonstrated Execution Excellence with a track record of leading complex projects, managing multiple priorities simultaneously in a fast-paced environment. + Strong Emotional Intelligence to foster trust and respect within a complex, matrixed organizational structure. + Exceptional Networking & Partnerships skills to collaborate effectively across diverse teams and stakeholders. + Agile mindset as a Change Catalyst, committed to experimenting, learning, and adapting in response to evolving business needs, and capable of driving continuous improvement. + Expertise in interpreting and communicating complex scientific concepts clearly in both one-on-one and group settings. + Deep knowledge of the US healthcare system, including national treatment guidelines, clinical research processes, FDA regulations, and OIG compliance. + The ability to travel up to 40% (i.e.: Congresses and internal meetings) **Preferred** + Field Medical Affairs experience. + University-level teaching experience and understanding of adult learning principles. + Experience with innovative pharmaceutical training platforms. + Proficiency in Microsoft Word, PowerPoint, and Excel. + Ability to quickly assimilate new subject areas and work independently on complex problems \#eligiblefor ERP **Required Skills:** Adaptability, Adaptability, Advisory Board Development, Biomarker Development, Business Decisions, Clinical Development, Clinical Medicine, Clinical Research, Clinical Trials, Collaboration, Data Analysis, Decision Making, FDA Regulations, Healthcare Management, Management Process, Medical Affairs, Medical Care, Medical Knowledge, Medical Marketing Strategy, Medication Safety, Professional Networking, Scientific Communications, Stakeholder Engagement, Strategic Planning, Strategic Thinking {+ 1 more} **Preferred Skills:** Current Employees apply HERE (***************************************************** Current Contingent Workers apply HERE (***************************************************** **US and Puerto Rico Residents Only:** Our company is committed to inclusion, ensuring that candidates can engage in a hiring process that exhibits their true capabilities. Please click here (*************************************** if you need an accommodation during the application or hiring process. As an Equal Employment Opportunity Employer, we provide equal opportunities to all employees and applicants for employment and prohibit discrimination on the basis of race, color, age, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, disability status, or other applicable legally protected characteristics. As a federal contractor, we comply with all affirmative action requirements for protected veterans and individuals with disabilities. For more information about personal rights under the U.S. Equal Opportunity Employment laws, visit: EEOC Know Your Rights (****************************************************************************************** EEOC GINA Supplement We are proud to be a company that embraces the value of bringing together, talented, and committed people with diverse experiences, perspectives, skills and backgrounds. The fastest way to breakthrough innovation is when people with diverse ideas, broad experiences, backgrounds, and skills come together in an inclusive environment. We encourage our colleagues to respectfully challenge one another's thinking and approach problems collectively. Learn more about your rights, including under California, Colorado and other US State Acts (********************************************** **U.S. Hybrid Work Model** Effective September 5, 2023, employees in office-based positions in the U.S. will be working a Hybrid work consisting of three total days on-site per week, Monday - Thursday, although the specific days may vary by site or organization, with Friday designated as a remote-working day, unless business critical tasks require an on-site presence.This Hybrid work model does not apply to, and daily in-person attendance is required for, field-based positions; facility-based, manufacturing-based, or research-based positions where the work to be performed is located at a Company site; positions covered by a collective-bargaining agreement (unless the agreement provides for hybrid work); or any other position for which the Company has determined the job requirements cannot be reasonably met working remotely. Please note, this Hybrid work model guidance also does not apply to roles that have been designated as "remote". The salary range for this role is $210,400.00 - $331,100.00 This is the lowest to highest salary we in good faith believe we would pay for this role at the time of this posting. An employee's position within the salary range will be based on several factors including, but not limited to relevant education, qualifications, certifications, experience, skills, geographic location, government requirements, and business or organizational needs. The successful candidate will be eligible for annual bonus and long-term incentive, if applicable. We offer a comprehensive package of benefits. Available benefits include medical, dental, vision healthcare and other insurance benefits (for employee and family), retirement benefits, including 401(k), paid holidays, vacation, and compassionate and sick days. More information about benefits is available at ****************************************************** . You can apply for this role through **************************** (or via the Workday Jobs Hub if you are a current employee). The application deadline for this position is stated on this posting. **San Francisco Residents Only:** We will consider qualified applicants with arrest and conviction records for employment in compliance with the San Francisco Fair Chance Ordinance **Los Angeles Residents Only:** We will consider for employment all qualified applicants, including those with criminal histories, in a manner consistent with the requirements of applicable state and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance **Search Firm Representatives Please Read Carefully** Merck & Co., Inc., Rahway, NJ, USA, also known as Merck Sharp & Dohme LLC, Rahway, NJ, USA, does not accept unsolicited assistance from search firms for employment opportunities. All CVs / resumes submitted by search firms to any employee at our company without a valid written search agreement in place for this position will be deemed the sole property of our company. No fee will be paid in the event a candidate is hired by our company 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. **Employee Status:** Regular **Relocation:** No relocation **VISA Sponsorship:** No **Travel Requirements:** 25% **Flexible Work Arrangements:** Remote **Shift:** Not Indicated **Valid Driving License:** No **Hazardous Material(s):** n/a **Job Posting End Date:** 02/3/2026 ***A job posting is effective until 11:59:59PM on the day** **BEFORE** **the listed job posting end date. Please ensure you apply to a job posting no later than the day** **BEFORE** **the job posting end date.** **Requisition ID:** R381371

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

At Navista, our mission is to empower community oncology practices to deliver patient-centered cancer care. Navista, a Cardinal Health company, is an oncology practice alliance co-created with oncologists and practice leaders that offers advanced support services and technology to help practices remain independent and thrive. True to our name, our experienced team is passionate about helping oncology practices navigate the future. The Chief Medical Officer, Navista serves as the clinical leader for Navista's oncology solutions platform, providing strategic, clinical, and operational oversight to ensure high-quality, evidence-based cancer care delivery across participating practices and health system partners. This role guides clinical strategy, supports the development and adoption of clinical pathways, collaborates with technology and product teams, and acts as a trusted clinical voice for customers and internal stakeholders. The Chief Medical Officer will help advance value-based oncology care, drive utilization of Navista's tools, support business development, and represent the medical perspective in product innovation and practice engagement. This position reports to SVP/GM of Navista. **Responsibilities** **Clinical Leadership, Governance, & Strategy** + Provide medical leadership for Navista's oncology services across the alliance with a focus on supporting emerging therapies and care advancements. + Guide the creation, maintenance, and governance of evidence-based clinical pathways and quality standards. + Oversee quality assurance programs and partner on the P&T committee to support pharmacy operations. + Collaborate with practice leadership to monitor provider performance, define clinical priorities, and develop long-term strategic plans to support the practice of the future. + Monitor emerging research, guidelines, regulations, and value-based care models to ensure Navista offerings remain clinically current and competitive. + Serve as Navista's clinical liaison to the payer team, providing expertise in value-based care and guiding clinical considerations during negotiations + Serve as Navista's clinical liaison to the RCM team, providing expertise in guiding clinical standards and workflows **Physician Engagement & Collaboration** + Act as liaison between Navista and alliance physicians, fostering strong relationships and ensuring alignment on clinical priorities and future strategies. + Facilitate communication across multidisciplinary care teams, including nursing, pharmacy, radiation services, and supportive care teams. + Participate in physician recruitment, onboarding, and retention strategies. **Technology Solutions Collaboration** + Serve as the clinical voice for technology solutions, informing requirements, workflows, user experience, and technology integrations. + Collaborate with analytics teams to validate clinical logic, measure outcomes, and improve performance across practices. + Evaluate opportunities for clinical AI, predictive analytics, care management, and advanced clinical decision-support capabilities. **Program Development & Support** + Lead strategic clinical initiatives to enhance oncology service lines and support deployment of new clinical programs. + Act as a trusted advisor to oncology practices, health systems, and payer partners to implement care pathways, utilization management strategies, and value-based care programs. + Provide clinical insights to the operations team with a focus on continuous operational improvement + Lead clinical discussions during practice integrations, optimizations, and performance reviews. + Provide clinical education on pathways, value-based care, and the use of Navista tools to improve outcomes and reduce variation. **Business Development Support** + Provide support in business development efforts through meeting with potential alliance partners to share our clinical and clinical business based priorities. + Be viewed as an industry thought leader by presenting at national events to demonstrate our relevance in the field of oncology care. + Proactive outreach to practice connections in community oncology. **Quality, Safety, & Performance Improvement** + Ensure compliance with all regulatory, accreditation, and clinical quality standards. + Develop metrics and dashboards to monitor pathway adherence, quality outcomes, and practice performance. + Partner with practices to identify opportunities to improve care quality, operational efficiency, and outcomes under value-based reimbursement models. + Support development of clinical research programs and real-world evidence initiatives leveraging Navista data. + Stay current with oncology advancements and emerging therapies to inform Navista strategy. **External Representation** + Represent Navista at professional meetings, stakeholder forums, advisory committees, and industry events. + Build relationships with key oncology leaders, societies, and innovators. + Contribute to publications, white papers, and thought leadership on oncology care transformation. **Qualifications** + MD or DO with board certification in Medical Oncology or Hematology/Oncology required + Minimum 10+ years of clinical oncology experience preferred + Demonstrated expertise in evidence-based oncology practice, care pathways, and/or value-based care models + Strong communication skills with experience engaging both clinicians and non-clinical stakeholders + Ability to interpret clinical data and partner effectively with analytics and technology teams + Experience in clinical leadership roles at provider organizations, payer organizations, or healthcare technology companies + Familiarity with clinical informatics, EHR workflows, or decision-support systems + Experience with OCM, EOM, or other value-based oncology payment models + Prior involvement in guideline or pathway development + Understanding of healthcare economics and quality improvement methodologies **Anticipated salary range** : $176,400 - $330,865 **Bonus eligible** : Yes **Benefits** : Cardinal Health offers a wide variety of benefits and programs to support health and well-being. + Medical, dental and vision coverage + Paid time off plan + Health savings account (HSA) + 401k savings plan + Access to wages before pay day with my FlexPay + Flexible spending accounts (FSAs) + Short- and long-term disability coverage + Work-Life resources + Paid parental leave + Healthy lifestyle programs **Application window anticipated to close** : 2/2/2026 *if interested in opportunity, please submit application as soon as possible. The salary range listed is an estimate. Pay at Cardinal Health is determined by multiple factors including, but not limited to, a candidate's geographical location, relevant education, experience and skills and an evaluation of internal pay equity. _Candidates who are back-to-work, people with disabilities, without a college degree, and Veterans are encouraged to apply._ _Cardinal Health supports an inclusive workplace that values diversity of thought, experience and background. We celebrate the power of our differences to create better solutions for our customers by ensuring employees can be their authentic selves each day. Cardinal Health is an Equal_ _Opportunity/Affirmative_ _Action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, ancestry, age, physical or mental disability, sex, sexual orientation, gender identity/expression, pregnancy, veteran status, marital status, creed, status with regard to public assistance, genetic status or any other status protected by federal, state or local law._ _To read and review this privacy notice click_ here (***************************************************************************************************************************

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

Manages, supervises, and coordinates all physician office operations while exemplifying Allergy Partners culture and values. Promotes a positive patient experience through professionalism and accountability. Performs routine financial management. Communicates with Physicians and Regional Operations Manager to ensure maintenance and growth of an efficient physician practice operation. Responsibilities include, but are not limited to the following: Personnel Manages all staffing needsscreens all applicants, facilitates hiring of practice staff and conducts performance reviews. Coordinates staff merit increases, promotions, and disciplinary actions. Reviews personnel problems with physicians and Regional Operations Manager. Consults with Regional Operations Manager and Human Resources prior to termination of any employee. Completes and updates personnel filesensures required forms are completed. Monitors and approves staff time and attendance records. Manage and approve all time off while maintaining appropriate staffing levels. Ensures all job functions are filled by trained personnel during periods of absences, filling in when needed. Maintains high morale and good relations with all stakeholders. Holds staff meetings at least monthly; prepares meeting minutes, and distributes them to staff, physician(s) and Regional Operations Manager. Regularly disseminates relevant information from Administration to necessary staff Models the AP Code of Conduct and demonstrates a commitment to the AP Compliance Program, standards and policies. Completes all assigned AP training (such as CPR, OSHA, HIPAA, Compliance, Information Security, others) within designated timeframes. Complies with Allergy Partners and respective hub/department policies and reports incidents of policy violations to a Supervisor/Manager/Director, Department of Compliance & Privacy or via the AP EthicsPoint hotline. Business Operations Ensures office is opened and closed daily, according to protocol and maintains a leadership presence during operating hours. Ensures that staff validate insurance eligibility and prior authorization requirements in accordance with business lines, specialty services lines and Practice Manager checklist. Oversees and distributes work activities and staff schedules. Manages petty cash, daily-balance submissions, and deposits in accordance with company guidelines. Ensures consistent collection of payment at time of service. Reviews daily reports and ensures check-out staff accurately completed the daily close requirements. Actively participates in the marketing program as defined by Allergy Partners. Reviews accounts receivable reports regularly; brings aged claim balances and rejection patterns to the attention of departments and Regional Operations Manager. Effectively manages collection accounts. Speaks with patients who have large, outstanding balances and attempts to collect on the account or arrange a payment plans prior to referring to external collections. Reviews monthly internal financial and management reports with Regional Operations Managers and physicians with the goal of identifying trends or outliers and enacting appropriate operational changes. Other Maintains facility and all office and clinical equipment in accordance with Allergy Partners Practice Manager Checklist. Effectively manages medical practice procurement for both clinical and general office supplies. Keeps all physician files up to date: hospital privileges, licensure, managed care plan credentials, malpractice insurance, and CME. Maintains patient confidentiality; complies with HIPAA and compliance guidelines established by Allergy Partners. Attends CPR/BLS, OSHA, HIPAA, OIG, and all other training programs as required. Attends annual Practice Management meeting and participates in monthly Practice Manager conference calls. Meets with Regional Operations Manager and physicians to discuss operational, financial, and clinical management issues. Collaborates with physicians and corporate departments to facilitate market growth expectations. Responsible for effective patient communications (i.e. closures, delays, protocol updates, hours of operation, etc.). Completes other duties as assigned. Models the AP Code of Conduct and demonstrates a commitment to the AP Compliance Program, standards and policies. Completes all assigned AP training (such as CPR, OSHA, HIPAA, Compliance, Information Security, others) within designated timeframes. Complies with Allergy Partners and respective hub/department policies and reports incidents of policy violations to a Supervisor/Manager/Director, Department of Compliance & Privacy or via the AP EthicsPoint hotline. Supervisory Responsibilities This job has supervisory responsibilities which include the management of practice staff. Typical Physical Demands Position requires prolonged sitting, some bending, stooping, and stretching. Good eye-hand coordination and manual dexterity sufficient to operate a keyboard, photocopier, telephone, computer, and other office equipment is also required. Employee must have normal range of hearing and eyesight to record, prepare, and communicate appropriate reports. Typical Working Condition Normal office environment. Occasional evening or weekend work. Qualifications EDUCATIONAL REQUIREMENTS: Undergraduate degree in business administration, healthcare administration, or similar discipline preferred. Extensive multi-disciplinary healthcare leadership experience may be taken into consideration in lieu of degree. QUALIFICATIONS AND EXPERIENCE: A minimum of three years of work experience, with increased responsibility, in a medical office or related business office. Experience facilitating revenue cycle processes. Experience supervising medical office staff preferred. Knowledge of practice management/EHR applications, comfort using Microsoft Office and other web-based systems. Ability to problem solve and perform multiple/diverse tasks simultaneously. Solid understanding of scheduling efficiency and patient flow in a medical practice. Experience with fiscal management. Excellent communication skills with both patients and staff in a variety of circumstances. Engaging and encouraging a positive experience for our patients, their families, and our staff. A can-do attitude that shows initiative, teamwork, and willingness to adopt to change. Upholds a neat, professional environment.

You could be just the right applicant for this job Read all associated information and make sure to apply. The Clinical Nurse Manager is responsible for the management of clinical nursing services. Works closely with the Director, and Medical Staff leadership to develop, implement, and maintain clinical and educational programs that enhance the quality of care and achieve a high level of patient and provider satisfaction. Requirements MINIMUM QUALIFICATIONS: EDUCATION: Graduate of an accredited program for Registered Nursing. BSN preferred. CERTIFICATION/LICENSES: R.N. with current New Mexico State license. BLS issued through American Heart Association, and other certification as applicable to area. National certification in area of expertise is preferred. SKILLS: Strong clinical and leadership skills and previous management experience including experience in facilitating interdisciplinary team collaboration. Evidence of such experience should include: Strong nursing knowledge and clinical skills Effective communication skills (verbal and written) Strong analytical skills Ability to problem solve; ability to appropriately confront issues Ability to motivate others as individuals and as a team Ability to plan, organize, direct, and manage the activities of others Ability to effectively run meetings and to negotiate deadlines. Ability to communicate with a wide variety of audiences Experience in dealing with physicians on an administrative level and ability to work collaboratively with medical staff members and leadership EXPERIENCE: Minimum of 5 years experience in clinical role in medical/surgical services. xevrcyc Two years progressive management experience.

**Become a part of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement to make determinations whether requested services, requested level of care, and/or requested site of service should be authorized at the Initial and Appeals/Disputes level. All work occurs within a context of regulatory compliance, and work is assisted by diverse resources, which may include national clinical guidelines, CMS policies and determinations, clinical reference materials, internal teaching conferences, and other reference sources. Medical Directors will learn Medicare, Medicaid, 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, and possible participation in care management. The clinical scenarios predominantly arise from outpatient, inpatient or post-acute care environments. Has 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. Some roles include an overview of coding practices and clinical documentation, disputes processes, 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 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/outpatient environment and/or related to care of a Medicare type population (disabled or >65 years of age). + Current and ongoing Board Certification an approved ABMS Medical Specialty + A current and unrestricted license in at least one jurisdiction and willing to obtain additional license, if required. + No current sanction from Federal or State Governmental organizations, and able to pass credentialing requirements. + Excellent verbal and written communication skills . + Evidence of analytic and interpretation skills, with prior experience participating in teams focusing on quality management, utilization management, 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. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial health insurance. + Experience with national guidelines such as MCG or InterQual + Internal Medicine, Family Practice, Geriatrics, Hospitalist, Emergency Medicine clinical specialists + Advanced degree such as an MBA, MHA, MPH + Exposure to Public Health, Population Health, analytics, and use of business metrics. + Experience working with Case managers or Care managers on complex case management, including familiarity with social determinants of health. + The curiosity to learn, the flexibility to adapt and the courage to innovate + Ability to obtain additional medical licenses **Additional Information** Typically reports to Lead depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an assigned market, member population, or condition type. May also engage in disputes and appeals reviews. May participate on project teams or organizational committees. \#physiciancareers Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. **Scheduled Weekly Hours** 40 **Pay Range** The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $223,800 - $313,100 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. **Description of Benefits** Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. Application Deadline: 01-31-2026 **About us** Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. **Equal Opportunity Employer** It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our ***************************************************************************

Sumitomo Pharma Co., Ltd., is a global pharmaceutical company based in Japan with operations in the U.S. (Sumitomo Pharma America, Inc.), focused on addressing patient needs in oncology, urology, women's health, rare diseases, cell & gene therapies and CNS. With several marketed products and a diverse pipeline of early- to late-stage investigational assets, we aim to accelerate discovery, research, and development to bring novel therapies to patients sooner. For more information on SMPA, visit our website ********************************** or follow us on LinkedIn. We are currently seeking a dynamic, highly motivated, and experienced individual for the position of Senior Medical Director, Clinical Development - Oncology. The senior medical director is responsible for the leadership, development, and management of clinical studies while building and maintaining relationships with investigators and key opinion leaders. **Job Duties and Responsibilities** + Lead and demonstrate ownership of the design and implementation of a clinical development program or programs in support of the overall product development plan, based on strong medical and scientific principles, knowledge of compliance and regulatory requirements, markets, business operations, and emerging issues. + Oversee project-related education of investigators, study site personnel, and study staff. + Responsible for leading clinical study teams, monitoring overall study integrity, and review, interpretation, and communication of safety and efficacy data. + Present at scientific, medical, and regulatory meetings globally. + Develop and maintain relationships with academic investigators, pharmaceutical + undefined + Contribute to company's planned regulatory filings including authoring clinical sections for INDs, NDAs, and other related documents. + Partner with Drug Safety & Pharmacovigilance to assess the safety profile of compounds. + Maintain a high level of clinical and scientific expertise in the disease area(s) by reviewing the literature, attending medical/scientific meetings, and through personal interchanges with consultants, thought leaders, investigators, and internal stakeholders. + Author manuscripts and collaborate with cross-functional colleagues and thought leaders to meet publication plan objectives. + Maintain ethical standards of the highest level and have the knowledge and ability to comply with all relevant ethical, regulatory, and legal standards. + May participate in or lead clinical development contributions to due diligence or other business development activity. + As required by program needs, contribute in partnership with Discovery colleagues to the design and implementation of translational strategies. + Participate in meetings and committees of parent company or other affiliates. + Establish collaborative and productive relationships with the parent company, internal/external partners, and relevant affiliates. + Perform other duties as requested. **Key Core Competencies** + Ability to run a complex clinical research program with minimal direction + Extensive knowledge of clinical trial methodology, regulatory and compliance requirements governing clinical trials, and experience in development of clinical strategy and the design of study protocols + Proven leadership skills and ability to bring out the best in others on a cross-functional team; highly collaborative, team-oriented, and decisive + Able to lead through influence + Excellent communication and presentation skills are essential. + Identify the key competencies or attributes required to excel in the role. + Examples may include problem-solving, teamwork, communication, etc. + Highlight any specific qualities or traits that are important for success in the role. + These could include attention to detail, adaptability, creativity, etc. **Education and Experience** + Medical Doctor (MD), Doctor of Osteopathy (DO), or non-US equivalent of MD. + Completion of a residency program strongly preferred. + Completion of a subspecialty fellowship is desirable. + Experience in the treatment and management of myelofibrosis is recommended. + 5-10 years of pharmaceutical drug development experience required. The base salary range for this role is $284,320 to $355,400. Base salary is part of our total rewards package which also includes the opportunity for merit-based salary increases, short incentive plan participation, eligibility for our 401(k) plan, medical, dental, vision, life and disability insurances and leaves provided in line with your work state. Our robust time-off policy includes flexible paid time off, 11 paid holidays plus additional time off for a shut-down period during the last week of December, 80 hours of paid sick time upon hire and each year thereafter. Total compensation, including base salary to be offered, will depend on elements unique to each candidate, including candidate experience, skills, education and other factors permitted by law. Disclaimer: The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified. All personnel may be required to perform duties outside of their normal responsibilities from time to time, as needed. **Confidential Data** : All information (written, verbal, electronic, etc.) that an employee encounters is considered confidential. **Compliance** : Achieve and maintain Compliance with all applicable regulatory, legal and operational rules and procedures, by ensuring that all plans and activities for and on behalf of Sumitomo Pharma America (SMPA) and affiliates are carried out with the "best" industry practices and the highest ethical standards. It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability. **Mental/Physical Requirements** : Fast paced environment handling multiple demands. Must be able to exercise appropriate judgment as necessary. Requires a high level of initiative and independence. Excellent written and oral communication skills required. Requires ability to use a personal computer for extended periods of time. **Sumitomo Pharma America (SMPA)** **is an Equal Employment Opportunity (EEO) employer** Qualified applicants will receive consideration for employment without regard to race; color; creed; religion; national origin; age; ancestry; nationality; marital, domestic partnership or civil union status; sex, gender; affectional or sexual orientation; disability; veteran or military status or liability for military status; domestic violence victim status; atypical cellular or blood trait; genetic information (including the refusal to submit to genetic testing) or any other characteristic protected by law. Sumitomo Pharma Co., Ltd., is a global pharmaceutical company based in Japan with operations in the U.S. (Sumitomo Pharma America, Inc.), focused on addressing patient needs in oncology, urology, women's health, rare diseases, cell & gene therapies and CNS. With several marketed products and a diverse pipeline of early- to late-stage investigational assets, we aim to accelerate discovery, research, and development to bring novel therapies to patients sooner. For more information on SMPA, visit our website ********************************** or follow us on LinkedIn. Sumitomo Pharma America (SMPA) endeavors to make its application process accessible to all. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact SMPA at ********************************************** This contact information is for accommodation requests only and cannot be used to inquire about the status of applications. At Sumitomo Pharma America, our work is guided by the Sumitomo Pharma mission, vision and values, which tie closely to our company's cultural pillars. **Our** **Mission** _To broadly contribute to society through value creation based on innovative research and development activities for the betterment of healthcare and fuller lives of people_ _worldwide_ **Our** **Vision** _For Longer and Healthier Lives, we unlock the future with cutting edge technology and_ _ideas_

**We are offering a five thousand dollar sign-on bonus!** Sub-Acute, Long-Term Care is a sector of healthcare exploding with potential and work-life balance flexibility (no weekends or on call)! We are seeking a part-time (16-24 hours per week) Attending Physician/Medical Director for our Casa Real Center located in Albuquerque, NM, with potential float to nearby centers. This is a Dual Role Attending Physician/Medical Director. It is clinical in nature. Must be BC/BE Internal Medicine or Family Medicine with LTC Experience. AlignMed Partners is a national medical group dedicated to improving health outcomes among residents of skilled nursing and senior living facilities. Our physicians, nurse practitioners (NPs) and physician assistants (PAs) are supported by a clinical leadership team with a decades-long track record of excellence in post-acute and long-term care. At AlignMed, we believe in a better quality of life for all. Our mission is to elevate healthcare outcomes for our patients, providers, and partners. In living out our mission, we embrace the following pillars in our day-to-day operations. Responsibilities The Medical Director partners with the Regional Medical Director to promote the delivery of clinical services in a manner that fulfills the AlignMed Partners mission of achieving the highest levels of clinical quality, efficiency, and outcomes. This is accomplished by coordinating with Centers, Regional Management and AlignMed Partners to oversee the implementation, utilization, and outcomes measurement of AlignMed Partners Clinical Programs. The Medical Director is dually accountable to the Center Administrator and the AlignMed Partners Regional Medical Director for clinical care within the Center, accountable to the Center Administrator for delivery of clinical services as stipulated in the Medical Director Agreement, and accountable to the Regional Medical Director for the quality and efficiency of clinical services and outcomes within the Center. Medical Directors partner with the Center Administrator and Director of Nursing, to achieve the highest levels of Center performance in quality, safety, and efficiency. Our Medical Directors share accountability for Center success in the evolving environment of narrow referral networks and value-based reimbursement, providing effective and proactive. Qualifications M.D. or D.O. required. Board Certified in Internal Medicine or Family Medicine preferred, with maintenance of certification Geriatrics specialization is desirable. Certified Medical Director (CMD) through AMDA is desirable. Benefits *No-cap Incentive Compensation Program *Relocation bonus for eligible candidates. Eligibility will be determined by distance, experience, and priority *Health, Dental, and Vision plans *100% employer-paid ArmadaCare Plan: supplemental plan which provides reimbursement for many out-of-pocket medical, wellness, and pharmacy expenses, with an eight thousand max reimbursement for designated expenses and tiered pharmacy reimbursements for single and family plans *Paid Time Off, 6 Paid Holidays, Paid Sick Time, Bereavement Leave *Continuing Medical Education time off and reimbursement allotments *Reimbursement for primary state licensing renewal costs and primary board recertification fees *Reimbursement for DEA/CDS renewal fees *Malpractice insurance policy *401(k) plan and company-paid group life insurance Restrictions apply based on collective bargaining agreements, applicable state law and factors such as pay classification, job grade, location, and length of service. Posted Salary Range USD $200,000.00 - USD $300,000.00 /Yr. Genesis HealthCare, Inc. and all affiliated entities (collectively "Genesis") has a strong commitment to diversity that is fully supported and practiced by our officers and leadership team. Genesis provides equal employment opportunities to all employees and applicants for employment without regard to actual or perceived race, color, religion, gender, gender expression, gender identity, sex, sexual orientation, HIV status, national origin, age, disability, marital status, pregnancy, ancestry, citizenship, genetic information, amnesty, military status or status as protected veterans, or any other legally protected characteristic. Genesis is an Affirmative Action and Equal Opportunity Employer and our goal is to foster an inclusive and accessible workplace free from discrimination and harassment where everyone has equal opportunities to succeed.