Medical safety director full time jobs - 23 jobs

National Accounts Medical Director
Carebridge 3.8
Columbus, OH
Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. Alternate locations may be considered. The National Accounts Medical Director is responsible for serving as the Operational Medical Director for our care management models for our National Account clients. The medical director will be responsible for supporting the clinical vision and implementation to deliver an improvement in the health of the people we serve. The medical director supports product strategy/design through medical management that impact health care quality, cost, and outcomes, and improving access to the health improvement tools offered to clients/ members. The medical director provides clinical expertise in all aspects of utilization review and case management. Provides input on the clinical relevance to account reporting regarding use of medical services by members. Involved in identifying and managing medical utilization trends, emerging trends and market changes that impact the client and members. Responsible for proactively identifying and solutioning with account management, Sales RVP Medical Directors. How you will make an impact: * Day to day clinical responsibilities means that the medical director is directly involved in Utilization Management and Case Management. * Daily case reviews for both utilization and case management issues. (80/20 split) * Consistent adoption and implementation of all medical policies used for operational reviews. * Leading multidisciplinary rounds for case management /complex clinical management. * Peer-to-peer outreach for both utilization reviews and also for case management consultation with treating providers. * Clinical report reviews, trend management, benefit design consultation, and supporting overall clinical performance guarantee success. * The medical director will be responsible for supporting all state specific requirements that apply for each state where there is our business. Minimum Requirements: * Requires MD or DO and Board certification approved by one of the following certifying boards is required, where applicable to duties being performed, American Board of Medical Specialties (ABMS) or American Osteopathic Association (AOA). * Must possess an active unrestricted medical license to practice medicine or a health profession. * Unless expressly allowed by state or federal law, or regulation, must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US military base, vessel or any embassy located in or outside of the US. * Minimum of 10 years of clinical experience; or any combination of education and experience, which would provide an equivalent background. * For Health Solutions and Carelon organizations (including behavioral health) only, minimum of 5 years of experience providing health care is required. Additional experience may be required by State contracts or regulations if the Medical Director is filing a role required by a State agency. Preferred Qualifications: * Indiana MD license or compact state multi-licensure is preferred but not exclusive. * Board certification preferably in a Primary Health Specialty, Family or Internal medicine or Surgery (surgical specialty). * Knowledge and experience with population or segment health management is a plus. * Knowledge of the health insurance industry and the National Accounts segment is preferred. For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $ 250,236 to $411,102 Locations: Illinois, DC, Nevada. In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws. * The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law. Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ******************************************** for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
$250.2k-411.1k yearly Auto-Apply 60d+ ago

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Medical Director - Commercial
Elevance Health
Columbus, OH
Medical Director- Commercial Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. Candidates must reside near a location in the following states: CO, OH, IN, KY, MO, and WI. Schedule: Monday through Friday 8am-5pm CST or EST (If candidate is living in Colorado MST is fine). Weekend rotation coverage 5-6 weekends a year. The Medical Director- Commercial will be part of the Central Region team responsible for utilization review case management for local Commercial business in the CO, OH, IN, KY, MO, and WI markets. May be responsible for developing and implementing programs to improve quality, cost, and outcomes. May provide clinical consultation and serve as clinical/strategic advisor to enhance clinical operations. May identify cost of care opportunities. May serve as a resource to staff including Medical Director Associates. How you will make an impact: * Supports clinicians to ensure timely and consistent responses to members and providers. * Provides guidance for clinical operational aspects of a program. * Conducts peer-to-peer clinical reviews with attending physicians or other providers to discuss review determinations, and patients' office visits with providers and external physicians. * May conduct peer-to-peer clinical appeal case reviews with attending physicians or other ordering providers to discuss review determinations. * Serves as a resource and consultant to other areas of the company. * May be required to represent the company to external entities and/or serve on internal and/or external committees. * May chair company committees. * Interprets medical policies and clinical guidelines. * May develop and propose new medical policies based on changes in healthcare. * Leads, develops, directs, and implements clinical and non-clinical activities that impact health care quality cost and outcomes. * Identifies and develops opportunities for innovation to increase effectiveness and quality. Minimum Requirements: * Requires MD or DO and Board certification approved by one of the following certifying boards is required, where applicable to duties being performed, American Board of Medical Specialties (ABMS) or American Osteopathic Association (AOA). * Must possess an active unrestricted medical license to practice medicine or a health profession. * Unless expressly allowed by state or federal law, or regulation, must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US military base, vessel or any embassy located in or outside of the US. * Minimum of 10 years of clinical experience; or any combination of education and experience, which would provide an equivalent background. * For Health Solutions and Carelon organizations (including behavioral health) only, minimum of 5 years of experience providing health care is required. Additional experience may be required by State contracts or regulations if the Medical Director is filing a role required by a State agency. Preferred Qualifications: * General Surgeon or Primary Care specialties preferred. For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $238,320 to $393,228 Locations: Colorado, and Columbus, OH In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws. * The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law. Job Level: Director Equivalent Workshift: 1st Shift (United States of America) Job Family: MED > Licensed Physician/Doctor/Dentist Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ******************************************** for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
$238.3k-393.2k yearly 9d ago
Medical Director - OP Claims Mgmt
Humana 4.8
Columbus, OH
**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 ***************************************************************************
$223.8k-313.1k yearly 59d ago
Medical Director -Spine
CVS Health 4.6
Delaware, OH
At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day. Position SummaryAetna, a CVS Health Company, a Fortune 6 company, is one of the oldest and largest national insurers. That experience gives us a unique opportunity to help transform health care. We believe that a better care system is more transparent and consumer-focused, and it recognizes physicians for their clinical quality and effective use of health care resources. Practice Spine Surgery. . . . From Your Home! Aetna, a CVS Health Company, is hiring physicians that are board certified in Orthopedic Spine or Neurosurgery to expand Aetna's medical management program. This is an exciting opportunity to address member needs across the continuum of care and provide clinical expertise to the spine team. The medical directors are responsible for precertification reviews of claim determinations, and provide clinical, coding and reimbursement expertise using multiple computer based applications. This is a full time position, offering a salary with yearly raises, health insurance, 401K, stock plans and other benefits and an opportunity to use your skills but work regular hours in a remote position from anywhere in the United StatesThis is a remote based (work at home) based anywhere in the US. Aetna, a CVS Health Company, has an exciting opportunity for a Medical Director (Spine) that can be remote based, work from home. The Medical Director (Spine) will be a Subject Matter Expert (SME) with a background in Orthopedic Spine OR Neurosurgery, including post-graduate direct patient care experience specifically. Expands Aetna's medical management programs to address member needs across the continuum of care. Supports the Medical Management staff ensuring timely and consistent responses to members and providers. Leads all aspects of utilization review/quality assurance, directing case management Provides clinical expertise and business direction in support of medical management programs through participation in clinical team activities. Acts as lead business and clinical liaison to network providers and facilities to support the effective execution of medical services programs by the clinical teams. Responsible for predetermination reviews ad reviews of claim determinations, providing clinical, coding, and reimbursement expertise, using multiple computer based applications. Required Qualifications* 2 or more years of experience in Health Care Delivery System e. g. , Clinical Practice and Health Care Industry. * Active and current state medical license without encumbrances. * M. D. or D. O. , Board Certification in a Orthopedic Spine OR Neurosurgery, including post-graduate direct patient care experience specifically. Preferred Qualifications* Previous healthcare insurance experience. Education* 2 or more years of experience in Health Care Delivery System e. g. , Clinical Practice and Health Care Industry. * Active and current state medical license without encumbrances. * M. D. or D. O. , Board Certification in a Orthopedic Spine OR Neurosurgery, including post-graduate direct patient care experience. Pay RangeThe typical pay range for this role is:$174,070. 00 - $374,920. 00This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. This position also includes an award target in the company's equity award program. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan. No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility. For more information, visit ************* cvshealth. com/us/en/benefits We anticipate the application window for this opening will close on Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
$174.1k-374.9k yearly 33d ago
Medical Director Risk Management
Ohiohealth 4.3
Columbus, OH
**We are more than a health system. We are a belief system.** We believe wellness and sickness are both part of a lifelong partnership, and that everyone could use an expert guide. We work hard, care deeply and reach further to help people uncover their own power to be healthy. We inspire hope. We learn, grow, and achieve more - in our careers and in our communities. ** Summary:** The MDRM works daily with the Risk Managers and the lawyers and staff in the OGC addressing concerns impacting OhioHealth's liability with respect to professional liability claims and incidents and the review and oversight of practitioner claim trends from the organization's claims/incidence database. In partnering with System Quality, this role also identifies primary areas of risk and works with Quality to help focus on the organizational impact of risk, whether patient safety, reputational, or financial. This position will include reviewing potential claims for reporting to the OGC. This role is accountable for providing medical advice and support to the Risk Managers and OGC. This person must also be able to effectively work with the outside malpractice defense counsel to provide general medical advice with respect to malpractice claims defense when requested. The person will also support the patient grievance process at GMC and RMH. **Responsibilities And Duties:** 60% The Medical Director, Risk Management ("MDRM) will provide expertise and advice to support the Risk Management function throughout OhioHealth. The primary job duties of this individual are as follows, and as assigned: The MDRM will provide expert medical analysis of incidents, risk matters, and claims and may interact with patients and family regarding the same. The MDRM's general function is to be the primary medical expert/resource/advisor to the Risk Management department and the Office of the General Counsel ("OGC). This will include interaction with in-house lawyers and outside malpractice defense counsel on incidents and claims as requested. The MDRM will regularly attend the Risk Management/OGC Reserves meetings and provide advice and input on standard of care in connection with claims against OhioHealth for medical malpractice. The MDRM, in conjunction with the other OhioHealth Risk Managers, may from time to time cooperate and provide information and expertise to the Quality and Patient Safety and Peer Review staff and leadership to help manage risk and prevent patient care errors. The MDRM will be the primary medical expert reviewer of incidents and potentially compensable events (PCEs) as part of the OGC/RM "Significantly Involved Provider (SIP) program and provide SIP analyses to the Risk Managers and OGC lawyers managing litigation. 40% For Grant Medical Center (GMC) and Riverside Methodist Hospital (RMH), the MDRM will: Support, through collaboration with Patient Experience/Customer Service, the patient grievance process. In that regard, the MDRM will assist in or provide case evaluations, disclosures, review patient concerns and safety events, and make periodic calls and visits to patients and families when a physician or administrative representative is needed. The MDRM will attend the grievance committee meetings at GMC and RMH and participate in related system activities as appropriate. Support the campus VP of Clinical Affairs and collaborate with hospital leadership on matters affecting patient services. Oversee the system patient rights hotline and perform medical record reviews for potential patient harm as needed. **Minimum Qualifications:** Doctor of Osteopathic Medicine, Medical DoctorOLP - Ohio Licensed Physician - Ohio Medical Board **Additional Job Description:** **SPECIALIZED KNOWLEDGE** Experience in peer review, quality and safety. **Work Shift:** Day **Scheduled Weekly Hours :** 40 **Department** Legal Join us! ... if your passion is to work in a caring environment ... if you believe that learning is a life-long process ... if you strive for excellence and want to be among the best in the healthcare industry Equal Employment Opportunity OhioHealth is an equal opportunity employer and fully supports and maintains compliance with all state, federal, and local regulations. OhioHealth does not discriminate against associates or applicants because of race, color, genetic information, religion, sex, sexual orientation, gender identity or expression, age, ancestry, national origin, veteran status, military status, pregnancy, disability, marital status, familial status, or other characteristics protected by law. Equal employment is extended to all person in all aspects of the associate-employer relationship including recruitment, hiring, training, promotion, transfer, compensation, discipline, reduction in staff, termination, assignment of benefits, and any other term or condition of employment
$231k-325k yearly est. 60d+ ago
Risk Management - United States - 2026 ReEntry Program
Jpmorgan Chase & Co 4.8
Columbus, OH
JobID: 210687414 JobSchedule: Full time JobShift: Base Pay/Salary: New York,NY $90,000.00-$140,000.00 At JPMorganChase, we recognize that rewarding careers do not always follow a conventional path. We value the diversity, fresh perspective and wealth of experience that returning professionals can bring. The ReEntry program offers experienced professionals, who are currently on an extended career break of at least two years, the support and resources needed to relaunch their careers. The program spans over 30 locations worldwide. The ReEntry Program is a 15-week fellowship program, beginning April 20, 2026 and ending July 31, 2026 with the prospect of an offer for permanent employment with JPMorganChase at the end of the program. The permanent placements will be based on both business needs and candidate skill set. Please refer to our ReEntry Overview page for further information regarding the Program. Risk Management at JPMorganChase The Risk Management organization provides risk management and control oversight, operating independently of revenue-generating businesses. The organization encompasses all corporate and line-of-business aligned risk management functions in the region including a comprehensive risk governance framework. The firm's risk management framework and governance structure are intended to provide comprehensive controls and ongoing management of the major risks inherent in its business activities. It is also intended to create a culture of risk awareness and personal responsibility throughout the firm. The firm's ability to properly identify, measure, monitor, and report risk is critical to both its soundness and profitability. Job Responsibilities * Provide independent risk challenge and oversight * Identify and evaluate potential risks, including industry-specific risks in order to mitigate * Collaborate and partner effectively with senior leaders and other lines of business and functions * Maintain ongoing financial and organizational discipline * Deliver against new regulatory, industry and internal requirements and standards * Continue to look for opportunities to be more efficient while maintaining a strong control environment * Promote the highest standard of culture and conduct by identifying, analyzing and escalating issues What We Look For * Currently on a voluntary career break of at least 2 years * Bachelor's degree in a quantitative discipline * 3+ years of experience in Risk, Quantitative Finance or similar area * Strong quantitative and financial analysis skills * Solid understanding of financial products, corporate finance, financial modeling and market dynamics * Exceptional interpersonal, verbal and written communication skills * Preferred experience in credit risk, market risk, model risk, modeling, analytics, reporting, strategy, product owner experience * Preferred proficiency in Excel (VBA), Python, SQL, R, SAAS, Tableau
$90k-140k yearly Auto-Apply 59d ago
Drug Safety Specialist
Gifthealth
Columbus, OH
About Us At Gifthealth, we're revolutionizing the way people experience healthcare by simplifying the process of managing prescriptions and health services. Our mission is to provide a seamless, personalized, and efficient healthcare experience for all our customers. We're a dynamic, innovative, and customer-centric company dedicated to making a positive impact on people's lives. Position Summary The Drug Safety Specialist will play a critical role in ensuring patient safety and regulatory compliance by triaging, documenting, and escalating Adverse Events (AEs) and Product Complaints (PCs) related to pharmaceutical therapies. ** This is a hybrid position. Candidates will be expected to dedicate 2-3 days per week in the office in Columbus, Ohio. Key Responsibilities Monitor and evaluate safety data from multiple sources. Work with teams to manage product safety data. Improve internal drug safety processes. Support the product replacement process. Complete Adverse Event and or Product Complaint Documentation Follow company values and promote product safety compliance. Processing and oversight of adverse event/drug experience reports (serious and non-serious) and other safety related data. Support investigations and evaluations of adverse events, including reviewing pharmacy records and collaborating with cross-functional teams. Stay up-to-date with current drug safety regulations and guidelines. Engage with patients regarding adverse event and complaint details, then accurately complete all required documentation. Address patient concerns regarding drug product shipment through temperature assessments. Review and approve product replacement, as required. Apply clinical and regulatory knowledge to assess risk and determine appropriate escalation paths for adverse event reports. Play a key role in ensuring organizational compliance with FDA pharmacovigilance regulations and preventing regulatory risk. Independently evaluate the severity of patient-reported issues in alignment with internal SOPs and federal guidelines. Ensure compliance with internal procedures, regulatory requirements, and partner agreements to ensure inspection readiness at all times. Qualifications A minimum of two to four years of pharmacovigilance and/or clinical trial experience is required. If no pharmacovigilance or clinical trial experience, a medical degree (RN, PharmD, etc) with four to five years of clinical experience is required. Knowledge of pharmacovigilance regulations (CFR/GVP), ICH Guidelines and/or Good Clinical Practices (GCP). HIPAA compliant - handle confidential and sensitive information with discretion. Capable of discussing adverse events and complaints in a patient-facing setting. Experience in generating monthly safety reports and performing reconciliation. Meticulous attention to detail and the maintenance of precise documentation pertaining to safety data and related activities are required. Proactive, hardworking, and always willing to take on new tasks. Work Environment Location: Hybrid Columbus OH Schedule: Full-time May require additional availability or flexibility for escalations. Regular meetings with teams, departments, or leadership to ensure alignment. Key Essential Functions Must be able to sit and/or work at a computer for extended periods of time. Must be able to use standard office equipment, including a computer, keyboard, mouse, and telephone. Must be able to perform repetitive motions throughout the workday, including typing, reading, and reviewing documentation. Must be able to communicate effectively with internal and external stakeholders in person, via video conference, and in writing. Must be able to work during standard business hours. Employment Classification Status: Full-time FLSA: Exempt Equal Employment Opportunity (EEO) Statement Gifthealth is an Equal Opportunity Employer and prohibits discrimination and harassment of any kind. All employment decisions are made without regard to race, color, religion, sex, sexual orientation, gender identity, transgender status, national origin, age, disability, veteran status, or any other legally protected status. We celebrate diversity and are committed to creating an inclusive environment for all employees. If you do not meet every requirement but still feel you would be a great fit for this role, we encourage you to apply! Disclaimer This job description is intended to describe the general nature and level of work being performed. It is not intended to be an exhaustive list of all responsibilities, duties, or skills required of personnel. Gifthealth reserves the right to modify job duties or descriptions at any time. Salary Description $59K-$70K
$59k-70k yearly 35d ago
Health, Safety & Environment - Co-op Positions
Cummins 4.6
Columbus, OH
In this role, you will make an impact in the following ways: Assists with the application and use of engineering controls to control hazards and reduce risks in the facility or site. Helps to anticipate, identify, and evaluate hazardous conditions and practices. Develops basic hazard control designs, methods, procedures, and programs. Administers and communicates hazard control programs. Interprets and applies internal and external standards in support of hazard reduction and compliance. Responsibilities To be successful in this role you will need the following: Fundamentals of Health and Safety - Comprehensive knowledge of occupational health & safety. Detailed understanding of general industry standards and the requirements of the more frequently referenced standards. Includes knowledge of basic health and safety concepts such as hazard and risk assessment, personal protective equipment, behavior-based safety, machine/ equipment safety, confined space entry, etc. Health & Safety Professional Knowledge (Including Regulatory Compliance) - Health & Safety Professional Knowledge relates to having comprehensive knowledge of occupational safety and health compliance. Regulatory compliance deals with the regulatory requirements imposed on industry by local, state, provincial, national, and international organizations. Detailed understanding of how the provisions of the regulations, as applicable may be implemented in the workplace, rights and responsibilities under the various acts/ regulations/ rules, the appeals process, record keeping (OSHA), and Voluntary Protection Programs (OSHA). Understanding of general industry standards and the requirements of the more frequently referenced standards. Occupational Health & Safety Management System - An Occupational Health and Safety (OHS) management system provides a framework for managing OHS responsibilities, so they become more efficient and more integrated into overall business operations. OHS management systems are based on standards that specify a process of achieving continuously improved OHS performance and compliance with legislation. Risk Management - This skill involves health & safety management principles and system safety engineering techniques. This includes the elements of risk identification and management and an understanding of the function of hazard analysis in system requirements definition, preliminary and detailed design, test, operations, and maintenance activities. This skill includes an understanding of the function and application of hazard analysis tools and techniques in the correct system and engineering environment. This may include the application of hazard analysis tools. Incident Investigation - The method of reporting the occurrence of an occupational injury/illness, near hit, or property damage. Incident investigations determine how and why these failures occur. Employees should be able to perform a thorough, effective incident investigation including root cause analysis, 5-why analysis, and development of effective corrective actions. System Safety - This skill involves safety management principles and system safety engineering techniques. This includes the elements of risk identification and management, understanding of the function of hazard analysis in system requirements definition, preliminary and detailed design, test, operations, and maintenance activities. System safety includes understanding of the function and application of hazard analysis tools and techniques in the correct system and engineering environment. This may include the application of hazard analysis tools. Degree Programs Considered: Bachelor's, Master's, MBA, PhD Major Programs Typically Considered: All Engineering Majors (including MET and EET), All Supply Chain and Logistics Related Majors, Economics, Informatics, and Statistics. Qualifications 202 Monthly Salary Range by Degree Level (Non-Technical): Bachelor's - $3,500 - $4,400 Master's - $5,600 MBA - $7,000 - $9,400 2026 Monthly Salary Range by Degree Level (Technical): Bachelor's - $3,900 - $4,800 Master's - $6,000 PhD - $7,300 Please note that the salary range provided is a good faith estimate on the applicable range. The final salary offer will be determined after considering relevant factors, including a candidate's qualifications and experience, where appropriate. Co-op program criteria: Must be a full-time enrolled student pursuing an undergraduate or graduate degree at an accredited U.S. college/university Minimum 2.5 or above GPA preferred Must be able to complete a minimum of 4-months to 6-months or a maximum of a 12-months commitment Must be able to complete 40 hours per week Willingness to learn from others on the job Must be currently residing within the continental U.S. Compensation and Benefits Base salary rate commensurate with experience. Additional benefits vary between locations and include options such as our 401(k) Retirement Savings Plan, Cash Balance Pension Plan, Medical/Dental/Life Insurance, Health Savings Account, Domestic Partners Coverage and a full complement of personal and professional benefits. Cummins and E-verify At Cummins, we are an equal opportunity and affirmative action employer dedicated to diversity in the workplace. Our policy is to provide equal employment opportunities to all qualified persons without regard to race, gender, color, disability, national origin, age, religion, union affiliation, sexual orientation, veteran status, citizenship, gender identity and/or expression, or other status protected by law. Cummins validates right to work using E-Verify. Cummins will provide the Social Security Administration (SSA) and, if necessary, the Department of Homeland Security (DHS), with information from each new employee's Form I-9 to confirm work authorization. Ready to think beyond your desk? Apply for this opportunity to start your career with Cummins today. careers.cummins.com Not ready to apply but want to learn more? Join our Talent Community to get the inside track on great jobs and confidentially connect to our recruiting team: ******************************
$5.6k-6k monthly Auto-Apply 49d ago
Safety Director (Ashville, NC)
Wisconsin Coach Lines Inc.
Ashville, OH
Job Title: Director of Safety Job Type: Full Time (on site 5 days/week) Education Level: College Degree preferred but not required Salary Range: Commensurate with Experience * This opportunity is contingent upon the successful award of a contract* Summary: Bus Company Holdings US, LLC (dba Coach USA), a motorcoach transportation company, is looking for a full-time Director of Safety with a minimum of eight (8) years of experience in their area of expertise or in the transportation or logistics sector. The Director of Safety is responsible for overseeing and ensuring that the health and safety of our employees is top priority. The ideal candidate will have worked in the transit sector with a range of supervisory roles in their field of expertise, demonstrate excellence in development of Public Transportation Agency Safety Plans (PTASP), safety program development and oversight. The Safety Director reports directly to the VP of Safety. Essential Functions: * Protect the health and safety of employees and decrease the potential risk of disease, illness, injury and exposures to harmful substances * Reduce workers' compensation claims and costs * Improve efficiency by reducing the time spent replacing or reassigning injured employees, as well as reducing the need to find and train replacement employee * Minimize the potential for penalties assessed by various enforcement agencies by maintaining compliance with Federal and state regulations * Establish that all safety programs and policies are properly administered and adhered to * Implement training and inspection requirement for other enforcing agencies and/or certifying entities aligned with the Safety program * Administer accident claims, maintain and submit monthly loss control summaries and maintain accident files * Maintain Driver Qualification files including conducting annual file reviews maintaining safety performance history files and conduct MVRs and background checks on new hires * Maintain the Medial Management Program and record keeping * Manage Workers' Compensation claims filing reports and tracking claim progress * Conduct company safety meetings and facility inspections * Ensure OSHA compliance * Manage company drug testing program * Conduct Spill Prevention, Control and Countermeasures Training Required Qualifications: * Commercial Driver's License (CDL) "B" with a "P" endorsement preferred but not required * Excellent communication skills and presentation skills * Knowledge of Safety rules and Federal and State regulations for facilities and drivers * Ability to read, analyze and interpret common scientific, technical journals and legal documents that pertain to the management of chemicals, hazardous waste and agency regulations * Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists Interested candidates can apply at ***************** Coach USA is an Equal Employment Opportunity employer. In compliance with Federal and State equal employment opportunity laws, qualified applicants are considered for all positions without regard to race, color, religion, national origin, sex (including gender identity, sexual orientation, and pregnancy), age, genetic information, disability, veteran status, or other protected class.
$68k-106k yearly est. 15d ago
Safety Coordinator
Dugan & Meyers 3.6
Columbus, OH
Advance Your Career as a Safety Coordinator at Dugan & Meyers At Dugan & Meyers, we put people first-prioritizing safety, development, and long-term career growth. With over 90 years of success in the construction industry, we've built a reputation for excellence in General Construction, Construction Management, Design-Build, Water and Wastewater Construction, and Concrete Construction. Our ability to self-perform critical tasks and our collaborative approach make us stand out-and we're just getting started. Summary As a Safety Coordinator, you'll play a key role in promoting our Incident and Injury-Free (IIF) culture, ensuring that every co-worker goes home safely every day. This is a field-focused position, with at least 90% of the time spent on-site observing, coaching, and engaging with crews. You'll provide leadership and mentorship to both co-workers and Field Safety Representatives, reinforcing safe behaviors, correcting hazards, and supporting overall project success. This role is hands-on, proactive, and deeply embedded in the operations team to drive improvements in safety, quality, and productivity (SQP). Roles and Responsibilities As Field Safety Manager, you'll be expected to demonstrate competence in the following areas: * Be a Visible Safety Resource - Promote and embody our IIF culture on job sites. * Ensure Safety Compliance - Support project adherence to all company and regulatory safety requirements. * Case Management - Conduct incident investigations and oversee job site case reporting. * Leadership - Supervise and mentor Field Safety Representatives. * Site Safety Oversight - Proactively identify and correct unsafe conditions and behaviors. * Training & Development - Participate in and support safety training and certifications for field staff. Requirements * Bachelor's Degree in a safety-related field and at least 4 years of concrete construction and safety experience, or an equivalent combination of education and field experience. * OSHA 500 certification or completion of a recognized safety-related training program is required. * Certification: Possession of CPR, AED, First Aid, and Bloodborne Pathogens certifications is highly desirable. * Technical Proficiency: Strong computer skills, including professional use of email, Dropbox, and the full Microsoft Office suite (Word, Excel, PowerPoint, Outlook). * Strong understanding of construction operations and the ability to influence field teams in a fast-paced, hands-on environment. At Dugan & Meyers, we're looking for people who take the initiative and make things happen. You'll be supported by a team that invests in your growth, rewards your effort, and gives you room to lead. In return, you'll receive: * Competitive pay * Excellent benefits * Career advancement opportunities * A chance to make a real impact in building better structures and better lives Dugan & Meyers is proud to be an Equal Opportunity Employer and member of the Drug Free Safety Program Details Employee Type Full-Time Regular Location Columbus OH Apply Processing...
$53k-69k yearly est. 3d ago
Safety Coordinator
Mac Safety
Columbus, OH
We at MAC Safety seek out the best and brightest safety professionals in the country. With our current clientele, we are able to place safety professionals in fast-paced diverse environments. Our business model gives our employees the ability to grow not only their resume but their career. Our compensation packages are above industry standard and we believe we have built a culture that truly is family first. Position is paid hourly with overtime after 40hours, mileage reimbursement, health benefits and 401k. Responsibilities: Develop and execute health and safety plans/training in the workplace Prepare and enforce policies to establish a culture of health and safety Conduct training and presentations for health and safety matters and accident prevention Inspect equipment and construction projects to observe possible unsafe conditions Investigate accidents or incidents Recommend solutions to issues, improvement opportunities or new prevention measures Prepare safety permits/approvals Provide professional expertise Requirements College degree preferred or relative job experience OSHA Certification (10, 30, 510, or 500) in Construction Preferred Ability to work all shifts (day/night/weekends) Good communication skills Proficient Word/Excel/Powerpoint Valid Driver's License Salary Description Based on years of experience & college degrees
$46k-74k yearly est. 60d+ ago
Fire Safety Coordinator
Columbus State Community College 4.2
Columbus, OH
The College Fire Safety Coordinator performs fire system management and coordinates inspections. The Program Coordinator processes invoices, performs procurement related duties, and under the direction of the Supervisor, ensures budgetary alignment. This position will also coordinate the college-wide safety systems to ensure legal and regulatory compliance with local, state, and federal laws. This role has the authority to make recommendations based on expertise, policy, best practices, experience, knowledge of integrated systems, as well as the legal and regulatory compliance requirements and maintains effective relationships with regulatory agencies. This position is subject to call-in (24) twenty-four hours a day (7) seven days a week and may be required to work holidays or evenings outside of the scheduled workday. This work may occur on varied shifts and may be required to work overtime ESSENTIAL JOB FUNCTIONS Safety Systems Program Coordination Coordinates the College's safety systems to ensure compliance with local, state, and federal regulations. Oversees fire system monitoring and suppression systems, including inspections, testing, maintenance agreements, and vendor contracts. Coordinates fire system maintenance, inspection functions, and ensures programs and systems are administered in accordance with policy, regulations, and law. Serves as a liaison to applicable regulatory agencies, including city/municipal, State Fire Marshall, public safety agencies, and National Fire Protection Association (NFPA). Responds to critical incidents by evaluating and analyzing emergencies or hazards, and directing others in appropriate safety procedures. Provides support as needed to campus police. Coordinates inspections of fire suppression systems, including fire pumps, alarm systems, detectors, extinguishers, hydrants, standpipes, sprinkler systems and other fire safety devices, and oversees repairs. Safeguards College safety Health, and property. Responds to emergency situations in support of the College Police, evaluates the emergency hazard, and directs others regarding appropriate safety guidelines, precautions, and response. Strategically plans to position the College safety systems for the future. Complies with federal, state, and local fire code rules and regulations. Community Engagement Collaborates with other campus and non-campus partners to identify and develop solutions to safety system issues. Participates in various campus events and activities that promote campus safety. Engages in public contact via telephone, e-mail, on in-person to answer inquiries and provide assistance. Culture of Respect Fosters and maintains a safe environment of respect and inclusion for faculty, staff, students, and members of the community. Additional Duties & Responsibilities: Attends all required department meetings and trainings. Assists other College departments and personnel during peak times and special events that serve the College. May assist persons with mobility or other impairments. May be required to work weekends, holidays, or hours outside of the scheduled workday. MINIMUM EDUCATION AND EXPERIENCE REQUIRED: High School Diploma or GED . *An appropriate combination of education, training, coursework and experience may qualify a candidate. LICENSES AND CERTIFICATIONS: State Motor Vehicle Operator's License or demonstrable ability to gain access to work site(s). State of Ohio Fire Alarm Certification - Certificate, may be obtained during the probationary period. CSCC has the right to revise this position description at any time. This position description does not represent in any way a contract of employment. Full Time/Part Time: Full time Union (If Applicable): Scheduled Hours: 40 Additional Information In order to ensure your application is complete, you must complete the following: Please ensure you have all the necessary documents available when starting the application process. For all faculty positions (Instructor, Annually Contracted Faculty, and Adjunct), you will need to upload an unofficial copy of your transcript when completing your aplication. Prior to submitting your application, please review and update (if necessary) the information in your candidate profile as it will transfer to your application. If you are a current employee of Columbus State Community College, please log in to Workday to use the internal application process. Thank you for your interest in positions at Columbus State Community College. Once you have applied, the most updated information on the status of your application can be found by visiting your Candidate Home. Please view your submitted applications by logging in and reviewing your status.
$37k-43k yearly est. Auto-Apply 31d ago
Medical Director - Commercial
Carebridge 3.8
Columbus, OH
Medical Director- Commercial Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. Prefer candidates to reside in the following states: CO, OH, IN, KY, MO, and WI. Schedule: Monday through Friday 8am-5pm CST or EST (If candidate is living in Colorado MST is fine). Weekend rotation coverage 5-6 weekends a year. The Medical Director will be part of the Central Region team responsible for utilization review case management and appeals for local Commercial business in the CO, OH, IN, KY, MO, and WI markets. May be responsible for developing and implementing programs to improve quality, cost, and outcomes. May provide clinical consultation and serve as clinical/strategic advisor to enhance clinical operations. May identify cost of care opportunities. May serve as a resource to staff including Medical Director Associates. How you will make an impact: * Supports clinicians to ensure timely and consistent responses to members and providers. * Provides guidance for clinical operational aspects of a program. * Conducts peer-to-peer clinical reviews with attending physicians or other providers to discuss review determinations, and patients' office visits with providers and external physicians. * May conduct peer-to-peer clinical appeal case reviews with attending physicians or other ordering providers to discuss review determinations. * Serves as a resource and consultant to other areas of the company. * May be required to represent the company to external entities and/or serve on internal and/or external committees. * May chair company committees. * Interprets medical policies and clinical guidelines. * May develop and propose new medical policies based on changes in healthcare. * Leads, develops, directs, and implements clinical and non-clinical activities that impact health care quality cost and outcomes. * Identifies and develops opportunities for innovation to increase effectiveness and quality. Minimum Requirements: * Requires MD or DO and Board certification approved by one of the following certifying boards is required, where applicable to duties being performed, American Board of Medical Specialties (ABMS) or American Osteopathic Association (AOA). * Must possess an active unrestricted medical license to practice medicine or a health profession. * Unless expressly allowed by state or federal law, or regulation, must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US military base, vessel or any embassy located in or outside of the US. * Minimum of 10 years of clinical experience; or any combination of education and experience, which would provide an equivalent background. * For Health Solutions and Carelon organizations (including behavioral health) only, minimum of 5 years of experience providing health care is required. Additional experience may be required by State contracts or regulations if the Medical Director is filing a role required by a State agency. Preferred Qualifications: * General Surgeon or Primary Care specialties preferred. For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $262,152 to $393,228 Locations: Colorado. In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws. * The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law. Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ******************************************** for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
$262.2k-393.2k yearly Auto-Apply 60d+ ago
Medical Director - Nat'l UM Team 1wknd/mo
Humana 4.8
Columbus, OH
**Become a part of our caring community and help us put health first** Become a part of our caring community and help us put health first The Medical Director actively uses their medical background, experience, and judgement to make determinations whether requested services, level of care, and/or site of service should be authorized. All work occurs within a context of regulatory compliance, and work is assisted by diverse resources, which may include national clinical guidelines, CMS policies and determinations, clinical reference materials, internal teaching conferences, and other reference sources. Medical Directors will learn Medicare and Medicare Advantage requirements and will understand how to operationalize this knowledge in their daily work. Weekend work required one weekend per month with compensated days off during the work week The Medical Director's work includes reviewing of all submitted medical records, synthesizing complex hospital-based clinical scenarios, and providing expert decisioning on the requested services. They will have regular discussions with external providers by phone to gather additional clinical information and discuss determinations. Medical directors are expected to understand Humana processes with a focus on collaborative professional relationships. The ideal candidate will have a high degree of integrity, professionalism, resourcefulness, and enjoy working in a team-based environment. Medical Directors support Humana value throughout all activities. **Responsibilities** The Medical Director provides medical interpretation and determinations whether services provided by other healthcare professionals are concordant with national guidelines, CMS requirements, Humana policies, clinical standards, and (in some cases) contracts. After completion of structured and mentored training, daily work is performed with minimal direction, but with ready support from other team members. The ideal candidate enjoys working in a structured environment with expectations for consistency in thinking and authorship. Exercises independence in meeting departmental expectations and meets compliance timelines. + Conduct comprehensive, timely, and compliant medical necessity reviews for inpatient services + Maintain accountability for productivity, quality, and compliance metrics + Communicate determinations clearly both verbally and in writing + Demonstrate adaptability and willingness to learn evolving workflows, tools, and utilization management practices + **Weekend work required one weekend per month with compensated days off during the work week** **Use your skills to make an impact** **Use your skills to make an impact** **Required Qualifications** + MD or DO degree + 5+ years of direct clinical patient care experience post residency or fellowship, which preferably includes some experience in an inpatient environment and/or related to care of a Medicare type population (disabled or >65 years of age). + Current and ongoing Board Certification an approved ABMS Medical Specialty + A current and unrestricted license in at least one jurisdiction and willing to obtain additional license, if required. + No current sanction from Federal or State Governmental organizations, and able to pass credentialing requirements. + Excellent verbal and written communication skills. + Evidence of analytic and interpretation skills, with prior experience working in a team environment **Preferred Qualifications** + Knowledge of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical management organizations, hospitals/ Integrated Delivery Systems, health insurance, or other healthcare providers. + Utilization management experience in a medical management review organization, such as Medicare Advantage, Managed Medicaid, or Commercial health insurance. + Experience with national guidelines such as MCG or InterQual + Experience in hospital-based clinical practice, including specialties of Internal Medicine, Family Practice, Geriatrics, Hospitalist, Emergency Medicine, and hospital-based clinical specialists + The curiosity to learn and the flexibility to adapt to changes in order to enhance efficiency, productivity, and organizational goals. + Ability to thrive in a dynamic fast-paced, team-oriented environment. + Commitment to a culture of innovation, including being facile with using technology to improve workflows + Participate in educational activities by attending required conferences and also create content to lead/teach/present for individual subject matter contribution + Passionate about contributing to an organization's focus on consistency in outcomes, consumer experiences and a highly engaged team culture **Additional Information** The medical director reports to a Lead Medical Director. Participation in weekend work on a rotational basis to ensure cases are decisioned in a timely manner May participate on project teams or organizational committees. \#physiciancareers Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. **Scheduled Weekly Hours** 40 **Pay Range** The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $223,800 - $313,100 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. **Description of Benefits** Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. Application Deadline: 04-30-2026 **About us** Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. **Equal Opportunity Employer** It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our ***************************************************************************
$223.8k-313.1k yearly 60d+ ago
Medical Director -Spine
CVS Health 4.6
Delaware, OH
At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day. Position SummaryAetna, a CVS Health Company, a Fortune 6 company, is one of the oldest and largest national insurers. That experience gives us a unique opportunity to help transform health care. We believe that a better care system is more transparent and consumer-focused, and it recognizes physicians for their clinical quality and effective use of health care resources. Practice Spine Surgery. . . . From Your Home! Aetna, a CVS Health Company, is hiring physicians that are board certified in Orthopedic Spine or Neurosurgery to expand Aetna's medical management program. This is an exciting opportunity to address member needs across the continuum of care and provide clinical expertise to the spine team. The medical directors are responsible for precertification reviews of claim determinations, and provide clinical, coding and reimbursement expertise using multiple computer based applications. This is a full time position, offering a salary with yearly raises, health insurance, 401K, stock plans and other benefits and an opportunity to use your skills but work regular hours in a remote position from anywhere in the United StatesThis is a remote based (work at home) based anywhere in the US. Aetna, a CVS Health Company, has an exciting opportunity for a Medical Director (Spine) that can be remote based, work from home. The Medical Director (Spine) will be a Subject Matter Expert (SME) with a background in Orthopedic Spine OR Neurosurgery, including post-graduate direct patient care experience specifically. Expands Aetna's medical management programs to address member needs across the continuum of care. Supports the Medical Management staff ensuring timely and consistent responses to members and providers. Leads all aspects of utilization review/quality assurance, directing case management Provides clinical expertise and business direction in support of medical management programs through participation in clinical team activities. Acts as lead business and clinical liaison to network providers and facilities to support the effective execution of medical services programs by the clinical teams. Responsible for predetermination reviews ad reviews of claim determinations, providing clinical, coding, and reimbursement expertise, using multiple computer based applications. Required Qualifications* 2 or more years of experience in Health Care Delivery System e. g. , Clinical Practice and Health Care Industry. * Active and current state medical license without encumbrances. * M. D. or D. O. , Board Certification in a Orthopedic Spine OR Neurosurgery, including post-graduate direct patient care experience specifically. Preferred Qualifications* Previous healthcare insurance experience. Education* 2 or more years of experience in Health Care Delivery System e. g. , Clinical Practice and Health Care Industry. * Active and current state medical license without encumbrances. * M. D. or D. O. , Board Certification in a Orthopedic Spine OR Neurosurgery, including post-graduate direct patient care experience. Pay RangeThe typical pay range for this role is:$174,070. 00 - $374,920. 00This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. This position also includes an award target in the company's equity award program. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan. No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility. For more information, visit ************* cvshealth. com/us/en/benefits We anticipate the application window for this opening will close on: 02/27/2026Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
$174.1k-374.9k yearly 58d ago
Medical Director - Nat'l IP UM Team
Humana 4.8
Columbus, OH
**Become a part of our caring community and help us put health first** Become a part of our caring community and help us put health first The Medical Director actively uses their medical background, experience, and judgement to make determinations whether requested services, level of care, and/or site of service should be authorized. All work occurs within a context of regulatory compliance, and work is assisted by diverse resources, which may include national clinical guidelines, CMS policies and determinations, clinical reference materials, internal teaching conferences, and other reference sources. Medical Directors will learn Medicare and Medicare Advantage requirements and will understand how to operationalize this knowledge in their daily work. The Medical Director's work includes reviewing of all submitted medical records, synthesizing complex hospital-based clinical scenarios, and providing expert decisioning on the requested services. They will have regular discussions with external providers by phone to gather additional clinical information and discuss determinations. Medical directors are expected to understand Humana processes with a focus on collaborative professional relationships. The ideal candidate will have a high degree of integrity, professionalism, resourcefulness, and enjoy working in a team-based environment. Medical Directors support Humana value throughout all activities. **Responsibilities** The Medical Director provides medical interpretation and determinations whether services provided by other healthcare professionals are concordant with national guidelines, CMS requirements, Humana policies, clinical standards, and (in some cases) contracts. After completion of structured and mentored training, daily work is performed with minimal direction, but with ready support from other team members. The ideal candidate enjoys working in a structured environment with expectations for consistency in thinking and authorship. Exercises independence in meeting departmental expectations and meets compliance timelines. + Conduct comprehensive, timely, and compliant medical necessity reviews for inpatient services + Maintain accountability for productivity, quality, and compliance metrics + Communicate determinations clearly both verbally and in writing + Participate in rotational weekend work and occasional holiday responsibilities + Demonstrate adaptability and willingness to learn evolving workflows, tools, and utilization management practices **Work Schedule Monday - Friday w/standard weekends (about 5 per year on average) Eastern Time Zone hours** **Use your skills to make an impact** **Use your skills to make an impact** **Required Qualifications** + MD or DO degree + 5+ years of direct clinical patient care experience post residency or fellowship, which preferably includes some experience in an inpatient environment and/or related to care of a Medicare type population (disabled or >65 years of age). + Current and ongoing Board Certification an approved ABMS Medical Specialty + A current and unrestricted license in at least one jurisdiction and willing to obtain additional license, if required. + No current sanction from Federal or State Governmental organizations, and able to pass credentialing requirements. + Excellent verbal and written communication skills. + Evidence of analytic and interpretation skills, with prior experience working in a team environment + **Work Schedule Monday - Friday w/standard weekends (about 5 per year on average) Eastern Time Zone hours** **Preferred Qualifications** + Knowledge of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical management organizations, hospitals/ Integrated Delivery Systems, health insurance, or other healthcare providers. + Utilization management experience in a medical management review organization, such as Medicare Advantage, Managed Medicaid, or Commercial health insurance. + Experience with national guidelines such as MCG or InterQual + Experience in hospital-based clinical practice, including specialties of Internal Medicine, Family Practice, Geriatrics, Hospitalist, Emergency Medicine, and hospital-based clinical specialists + The curiosity to learn and the flexibility to adapt to changes in order to enhance efficiency, productivity, and organizational goals. + Ability to thrive in a dynamic fast-paced, team-oriented environment. + Commitment to a culture of innovation, including being facile with using technology to improve workflows + Participate in educational activities by attending required conferences and also create content to lead/teach/present for individual subject matter contribution + Passionate about contributing to an organization's focus on consistency in outcomes, consumer experiences and a highly engaged team culture **Additional Information** The medical director reports to a Lead Medical Director. Participation in weekend work on a rotational basis to ensure cases are decisioned in a timely manner May participate on project teams or organizational committees. \#physiciancareers Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. **Scheduled Weekly Hours** 40 **Pay Range** The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $223,800 - $313,100 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. **Description of Benefits** Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. Application Deadline: 04-30-2026 **About us** Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. **Equal Opportunity Employer** It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our ***************************************************************************
$223.8k-313.1k yearly 60d+ ago
Utilization Management Medical Director- NC Medicaid
Carebridge 3.8
Columbus, OH
Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. Ideal candidate will live in North Carolina but not required. Alternate locations may be considered. The Medical Director will be responsible for utilization review case management for North Carolina Medicaid. May be responsible for developing and implementing programs to improve quality, cost, and outcomes. May provide clinical consultation and serve as clinical/strategic advisor to enhance clinical operations. May identify cost of care opportunities. May serve as a resource to staff including Medical Director Associates. How you will make an impact: * Supports clinicians to ensure timely and consistent responses to members and providers. * Provides guidance for clinical operational aspects of a program. * Conducts peer-to-peer clinical reviews with attending physicians or other providers to discuss review determinations, and patients' office visits with providers and external physicians. * May conduct peer-to-peer clinical appeal case reviews with attending physicians or other ordering providers to discuss review determinations. * Serves as a resource and consultant to other areas of the company. * May be required to represent the company to external entities and/or serve on internal and/or external committees. * May chair company committees. * Interprets medical policies and clinical guidelines. * May develop and propose new medical policies based on changes in healthcare. * Leads, develops, directs, and implements clinical and non-clinical activities that impact health care quality cost and outcomes. * Identifies and develops opportunities for innovation to increase effectiveness and quality. Minimum Requirements: * Requires MD or DO and Board certification approved by one of the following certifying boards is required, where applicable to duties being performed, American Board of Medical Specialties (ABMS) or American Osteopathic Association (AOA). * Must possess an active unrestricted medical license to practice medicine or a health profession in North Carolina. * Unless expressly allowed by state or federal law, or regulation, must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US military base, vessel or any embassy located in or outside of the US. * Minimum of 10 years of clinical experience; or any combination of education and experience, which would provide an equivalent background. * For Health Solutions and Carelon organizations (including behavioral health) only, minimum of 5 years of experience providing health care is required. Additional experience may be required by State contracts or regulations if the Medical Director is filing a role required by a State agency. Preferred Qualifications: * Pediatrics board certification preferred. Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ******************************************** for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
$170k-258k yearly est. Auto-Apply 60d+ ago
Medical Director Medicaid
Humana 4.8
Columbus, OH
**Become a part of our caring community and help us put health first** The Medical Director relies on medical background and reviews health claims. The Medical Director work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. The Medical Director actively uses their medical background, experience, and judgement to make determinations whether requested services, requested level of care, and/or requested site of service should be authorized. All work occurs with a context of regulatory compliance, and work is assisted by diverse resources which may include national clinical guidelines, CMS policies and determinations, clinical reference materials, internal teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and Medicare Advantage requirements, and will understand how to operationalize this knowledge in their daily work. The Medical Director's work includes computer based review of moderately complex to complex clinical scenarios, review of all submitted clinical records, prioritization of daily work, communication of decisions to internal associates, and possible participation in care management. The clinical scenarios predominantly arise from 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, 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, and Humana's Bold Goal mission, throughout all activites. **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. Supports the assigned work with respect to market-wide objectives (e.g. Bold Goal) 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, 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 Regional Vice President of Health Services, Lead, or Corporate Medical Director, 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 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: 04-15-2026 **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 ***************************************************************************
$223.8k-313.1k yearly 6d ago
Medical Director - IP Claims Management
Humana 4.8
Columbus, OH
**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 ***************************************************************************
$223.8k-313.1k yearly 48d ago
Medical Director-Payment Integrity
Humana 4.8
Columbus, OH
**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 Inpatient 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 and communication of decisions to internal associates. The clinical scenarios predominantly arise from inpatient or post-acute care environments. A remote possibility exists of doing peer-to-peer discussions with an external provider. Some roles include an overview of coding practices and clinical documentation, dispute/grievance and appeals processes, and outpatient services and equipment, within their scope. Medical Directors support Humana values, and Humana's mission, 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 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 Lead Medical Director. 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 experience in an inpatient environment and/or related to care of a Medicare type population (disabled or >65 years of age). + Current and ongoing Board Certification an approved ABMS Medical Specialty + A current and unrestricted license in at least one jurisdiction and willing to obtain additional license, if required. + No current sanction from Federal or State Governmental organizations, and able to pass credentialing requirements. + Excellent verbal and written communication skills. + Evidence of analytic and interpretation skills, with prior experience 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, Hospitalist, Family Practice, Geriatrics, Emergency Medicine clinical specialists + Advanced degree such as an MBA, MHA, MPH + Exposure to Public Health, Population Health, analytics, and use of business metrics. + The curiosity to learn, the flexibility to adapt and the courage to innovate **Additional Information** Typically reports to a Lead Medical Director. The Medical Director conducts post-service, inpatient care reviews for accurate billing of clinically valid diagnoses and care received. May also engage in disputes and 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 ***************************************************************************
$223.8k-313.1k yearly 42d ago

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Updated January 20, 2026

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Medical safety director full time jobs - 23 jobs

National Accounts Medical Director

Medical Director - Commercial

Medical Director - OP Claims Mgmt

Medical Director -Spine

Medical Director Risk Management

Risk Management - United States - 2026 ReEntry Program

Drug Safety Specialist

Health, Safety & Environment - Co-op Positions

Safety Director (Ashville, NC)

Safety Coordinator

Safety Coordinator

Fire Safety Coordinator

Medical Director - Commercial

Medical Director - Nat'l UM Team 1wknd/mo

Medical Director -Spine

Medical Director - Nat'l IP UM Team

Utilization Management Medical Director- NC Medicaid

Medical Director Medicaid

Medical Director - IP Claims Management

Medical Director-Payment Integrity

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