Patient relations director work from home jobs

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 requeste?K

Medical Director - Medicare Programs Remote | Approx. $300,000 base + significant bonus potential About the Opportunity: A leading national healthcare contractor is seeking a Medical Director to provide clinical leadership and decision-making support for Medicare operations. This position plays a critical role in developing and enforcing coverage determinations, reviewing complex claims, and promoting evidence-based medical policy. The role is ideal for a physician, especially those with a background in Physical Medicine and Rehabilitation (PM&R), who wishes to transition from direct patient care into a leadership position influencing medical necessity and healthcare compliance at scale. Key Responsibilities: Clinical Leadership: Provide medical expertise for claim reviews, appeals, and Medicare policy development. Serve as a subject matter expert across multiple specialties. Policy Development: Collaborate with the Centers for Medicare & Medicaid Services (CMS) and other contractors to create, revise, and maintain Local Coverage Determinations (LCDs) and related guidance. Program Integrity: Identify trends in billing or compliance issues and work with investigative teams to address improper claims. Medical Review & Appeals: Oversee quality assurance in pre- and post-payment medical review determinations and assist with administrative law proceedings when necessary. Provider Education: Lead outreach and training for healthcare providers and professional associations to ensure adherence to Medicare policies and evidence-based practices. Travel is minimal (approximately 3-4 weeks per year), and the position is fully remote with occasional in-person meetings or conferences. Required Qualifications: MD or DO from an accredited institution. Active, unrestricted medical license in at least one U.S. state (must be eligible for additional licensure where required). Board Certification in a specialty recognized by the American Board of Medical Specialties (minimum three years). At least three years of experience as an attending physician. Prior experience within the Medicare, health insurance, or utilization review environment. Strong understanding of clinical evidence evaluation and medical necessity determination within fee-for-service structures. Excellent communication and collaboration skills across technical, regulatory, and clinical teams. Computer proficiency (MS Office, data analysis tools, virtual collaboration platforms). Preferred Qualifications: Background in PM&R, Internal Medicine, Oncology, Radiology, Ophthalmology, or Infectious Disease. Five or more years of clinical practice experience. Prior experience as a Medical Director in a Medicare or commercial payer organization. Familiarity with HCPCS, CPT, and ICD-10 coding standards. Advanced degree or coursework in healthcare administration or systems management (MBA, MHA, MS). Experience performing systematic literature reviews or using GRADE methodology. Compensation & Benefits: Base salary: Approximately $300,000, flexible depending on experience. Bonus structure: Significant performance-based bonuses. Benefits: Comprehensive health coverage, generous retirement contributions, paid time off, and strong professional development support. Schedule: Full-time, remote position with flexible hours. Why Join: This is an opportunity to move beyond clinical work while continuing to make a direct impact on patient access and policy integrity at a national level. Join a mission-driven organization that values medical expertise, promotes collaboration, and advances fairness and compliance within the U.S. healthcare system.

Medical Director (Utilization Management) The Medical Director plays a key role in ensuring coverage and payment determinations are clinically appropriate, compliant, and aligned with plan benefits and contractual agreements with participating provider networks. This position requires sound clinical judgment, collaborative leadership, and a strong understanding of healthcare delivery, population health, and payer operations. Key Responsibilities Provide physician leadership and clinical guidance to Utilization Management and Care Management functions Render coverage and payment determinations in accordance with health plan benefits, medical policies, and provider contracts Apply evidence-based clinical guidelines and best practices to support consistent, high-quality decision-making Exercise informed medical judgment grounded in clinical medicine, patient safety, quality management, and population health principles Collaborate effectively with clinical teams, operational leaders, senior management, and external partners Promote efficient, cost-effective care delivery across all lines of business Support organizational initiatives related to quality improvement, compliance, and healthcare outcomes Required Qualifications & Experience Medical Doctor (MD) or Doctor of Osteopathy (DO) from an accredited medical or osteopathic medical school recognized by AAMC, AOA, or WHO Unrestricted and active Pennsylvania medical or osteopathic license Current board certification through ABMS or AOBMS (Family Medicine or Internal Medicine preferred) Ability to successfully complete organizational credentialing requirements Strong knowledge of Utilization Management, healthcare delivery systems, and payer-based medical decision-making Work Location Fully Remote: This position is designated as fully remote Work must be performed within the Tri-State Area (Pennsylvania, New Jersey, or Delaware)

Reports Jointly To: Chief Executive Officer and Chief Medical Officer Clinical Specialty: MD, Board Certified in Sports Medicine (primary board specialty flexible) ViewFi is a nationwide virtual musculoskeletal (MSK) practice bringing high-quality orthopedic, sports-medicine, and physical-therapy care directly to patients in both traditional and non-traditional markets. We serve a diverse set of partners including personal injury/med-legal groups, self-insured employers, risk-based payers, and digital health collaborators in the sports and fitness markets through technology enabled, evidence-based clinical care. We are redefining what excellent MSK care looks like in a virtual environment. Position Summary The Medical Director will serve as the clinical leader of ViewFi's physician team and a core partner to our physical therapy, product, operations, and business teams. This role requires a practicing, board-certified Sports Medicine physician who can balance patient care with 30-40% administrative/leadership responsibilities. The Medical Director will ensure clinical excellence, maintain high-quality and consistent clinical pathways, represent ViewFi as the medical voice of the organization, and advance the science and evidence behind virtual MSK care. Key Responsibilities Clinical Leadership & Oversight Lead, oversee, and support the national team of physicians delivering virtual MSK care. Maintain and update clinical pathways, treatment standards, and practice guidelines across all ViewFi service lines. Partner closely with the Physical Therapy leadership team to ensure integrated, cohesive care between MDs and PTs. Ensure consistent, high-quality clinical documentation, coding accuracy, and compliance across markets. Oversee peer review, quality assurance activities, and clinical performance metrics. Participate in recruitment, onboarding, and ongoing development of new clinicians. Patient Care (70-80%) Actively see patients in a virtual setting, providing MSK consults and follow-ups. Model best-in-class virtual care workflows and contribute to continuous improvement of the patient experience. Support escalated or complex cases requiring senior clinical judgment. Strategic & Administrative Leadership (20-30%) Serve as the medical voice of ViewFi at conferences, webinars, panels, and partner meetings. Collaborate with executive leadership on product development, new service lines, geographic expansion and clinical innovation initiatives. Guide medical input for payers, partners, self-insured employers, and med-legal groups. Participate in strategic planning related to national expansion, licensure strategy, and resource allocation. Work cross-functionally with operations and technology teams to enhance clinical workflows. Provide medical insight and feedback on ViewFi's technology roadmap, including clinical decision support, AI integration, and general telehealth tools. Research, Publishing & Thought Leadership Lead or collaborate on clinical research demonstrating the efficacy of virtual MSK care, including both MSK MD consults and virtual PT. Publish and present outcomes, case series, and efficacy studies at relevant medical and industry conferences. Help build ViewFi's reputation as the leader in evidence-based virtual MSK care. Quality, Compliance & Risk Management Ensure the practice meets state and federal clinical guidelines, telehealth regulations, and licensure requirements. Maintain oversight of clinical incident review processes, risk-mitigation protocols, and outcome tracking. Drive continuous improvement in clinical quality, patient safety, and service reliability. Qualifications MD with Board Certification in Sports Medicine (primary board: FM, IM, EM, PM&R, etc. is flexible). Multi-state licensure required; willingness to pursue additional licensure required. Minimum 10 years of clinical experience; virtual care experience strongly preferred. Demonstrated leadership experience in a clinical or medical director role. Strong collaboration skills with PTs, operational teams, and cross-functional partners. Excellent communication and presentation skills; comfortable representing ViewFi publicly. Passion for virtual care, musculoskeletal medicine, and innovative delivery models. What We Offer Opportunity to lead a national MSK practice at the forefront of technology enabled virtual healthcare Collaborative environment with clinical and operational teams aligned around quality care and aggressive growth Competitive compensation with protected administrative time Support for conference travel, research, publishing, and clinical innovation Commitment to clinical excellence, patient outcomes, and provider support

Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together. Inpatient Utilization Management Medical Director works with Senior Medical Officers, Regional Medical Officers, Extensivists, the Healthcare Services Team (Case managers, Social Workers, Utilization Managers) to develop and implement methods to optimize use of Institutional and Outpatient services for all patients while also ensuring the quality of care provided. Through remote access to our web-based Portal, physician advisors will complete clinical reviews for medical necessity, treatment appropriateness and compliance. GENERAL DUTIES/RESPONSIBILITIES: Perform medical necessity utilization reviews primarily for inpatient and post-acute cases with some outpatient / pre-service reviews as needed in accordance with UM guidelines Lead concurrent review activities, including rounds, peer-to-peers, and utilization management strategies to improve clinical and efficiency outcomes Serve as a clinical leader and educator for the nursing / care management team Process claims reviews, appeals, and second-level reviews as needed in compliance with Medicare (NCD, LCD), internal, and third-party guidelines (e.g., MCG) for Inpatient, Outpatient, Skilled Facilities Level of Care and Pharmacy. Acts as a liaison between the medical staff, utilization review team, and 3rd parties to effectively promote clinically necessary and efficient utilization of care Serves as a Physician member of the utilization review team. Work with Interdisciplinary Teams to help manage complex or high risk cases Contributes to development of clinical strategies to improve member outcomes, efficiency metrics, and quality outcomes Duties may include serving on committees as needed, such as quality, utilization management, credentialing, etc Other duties as may be assigned to the medical director. Supervisory Responsibilities: Oversees assigned staff, if any. Responsibilities may include recruiting, selecting, orienting, and training employees; assigning workload; planning, monitoring, and appraising job results; and coaching, counseling, and disciplining employees. Experience: • Required: Minimum of 3 years of experience in hospital-wide or skilled nursing facility position involving clinical care, quality management, utilization / case management, or medical staff governance required • Preferred: Experience as a Physician Advisor or Medical Director a plus Education: Required: Completion of medical school and specialty residency (preferably in internal medicine). Preferred: Board-certification Specialized Skills: • Required: Ability to build rapport with medical staff and management leadership to obtain necessary approvals of new strategies for utilization management. Knowledge of current medical literature, research methodology, healthcare delivery systems, healthcare financial/reimbursement issues, and medical staff organizations. Dedication to the delivery of high-quality, cost-effective, efficient patient care services Effective written and oral communication skills; ability to establish and maintain a constructive relationship with diverse members, management, employees and vendors; Mathematical Skills: Ability to perform mathematical calculations and calculate simple statistics correctly Reasoning Skills: Ability to prioritize multiple tasks; advanced problem-solving; ability to use advanced reasoning to define problems, collect data, establish facts, draw valid conclusions, and design, implement and manage appropriate resolution. Problem-Solving Skills: Effective problem solving, organizational and time management skills and ability to work in a fast-paced environment. Licensure: • Required: Applicants must have current, non-restricted licensure as required for clinical practice in the state of California. Work Environment: This is a remote position. The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Essential Physical Functions: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. 1 While performing the duties of this job, the employee is regularly required to talk or hear. 2 The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms. 3 The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus. Pay Range: Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc. Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation. *DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at ******************************* If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health's talent acquisition team, please email ******************.

HealthPartners is looking for Medical Director to join our Home-Based Medicine team. This role will be a 1.0 FTE with 0.30 FTE dedicated to the medical director role and 0.70 dedicated to clinical. This is a unique opportunity to make a meaningful impact on the lives of patients with advanced illness by shaping the future of care delivered in the home. The Medical Director of Home-Based Medicine (HBM) will provide clinical and operational leadership across HealthPartners' innovative home-based care programs. You'll help define and guide best practices, scope of care, and clinical quality across multiple care pathways, including Home Based Primary Care, In Home Complex Care and Transitional Visits. This work is being done in close collaboration with the Advance Care Primary Care (ACPC) clinic, as well as many other departments caring for patients with advanced illness in this space. In addition to leadership responsibilities, the Medical Director will dedicate a portion of their time to direct patient care, primarily in the home setting, with a smaller portion of clinical work occurring in the Advanced Care Primary Care (ACPC) Clinic. You will be joining a team that is supportive and respectful of one another and deeply committed to the mission of HealthPartners. Here, you'll become a partner for good, helping to improve the health and well-being of our patients, members and community. Our commitment to excellence, compassion, partnership and integrity is behind everything we do. It's the type of work that makes a difference, the kind of work you can be proud of. We hope you'll join us. QUALIFICATIONS: The position requires board eligibility/board certification, preferably in Hospice and Palliative Care, Internal Medicine, or Family Medicine. Preferred candidates will have a minimum of 2 years leadership/administrative experience and demonstrate ongoing commitment to leadership development. The ideal candidate will have a deep understanding of innovative care models for complex patients within a diverse clinical setting. BENEFITS: HealthPartners benefit offerings (for 0.5 FTE or greater) include medical insurance, dental insurance, 401k with company contribution and match, 457(b) with company contribution, life insurance, AD&D insurance, disability insurance, malpractice insurance for work done on behalf of HealthPartners as well as a CME reimbursement account. Our clinician well-being program provides a wealth of information, tools, and resources tailored to meet the unique needs of our health care professionals, including physicians, advanced practice clinicians (APCs) and dentists. HealthPartners is a qualified non-profit employer under the federal Public Service Loan Forgiveness program. TO APPLY: For more information about the position or to apply, please contact Judy Brown, Sr. Physician and APC Recruiter at *********************************. For immediate consideration, please apply online.

Who We Are Ready to create a healthier world? We are ready for you! Personify Health is on a mission to simplify and personalize the health experience to improve health and reduce costs for companies and their people. At Personify Health, we believe in offering total rewards, flexible opportunities, and a diverse inclusive community, where every voice matters. Together, we're shaping a healthier, more engaged future. Responsibilities What You'll Actually Do: The Behavioral Health (BH) Medical Director leverages clinical expertise to provide leadership and oversight for behavioral health programs, ensuring high-quality, integrated care for members with behavioral health and substance use needs. Key responsibilities include: Oversee and participate in behavioral health case management, including utilization review, telephonic care, and urgent response coordination for behavioral health and substance use disorder needs. Conduct reviews for medical necessity for prior authorization, continued stay, and post-service claims, applying medical policy, guidelines, and current research. Integrate behavioral health screening and interventions within physical health case management programs, utilizing standardized tools (e.g., PHQ2, PHQ9) and ensuring appropriate referrals. Support and monitor virtual behavioral health services, ensuring access, privacy, and continuity of care for all age groups, including children, teens, and adults. Supervise and provide clinical oversight for residential and outpatient behavioral health programs, including partial hospitalization and intensive outpatient services, with an emphasis on family engagement and comprehensive discharge planning. Lead the development and implementation of comprehensive behavioral health strategies, including program design, staff education, and quality improvement initiatives. Maintain compliance with national guidelines (e.g., MCG, InterQual, specialty college recommendations) and regulatory requirements (federal, state, ERISA) specific to behavioral health. Oversee the negotiation and implementation of cost management strategies to affect quality outcomes, reflecting data in monthly case management reviews. Participate in grievance and appeals processes, including escalated behavioral health issues. Collaborate with the VP of Care Management to establish work procedures and processes that support company and departmental standards, procedures, and strategic directives. Keep teams informed of clinical and behavioral health updates through educational opportunities and development of educational materials. Exercise independence in meeting departmental expectations and compliance timelines. KEY COMPETENCIES: Expertise in behavioral health case management, utilization review and telehealth delivery. Ability to design and evaluate behavioral health programs, integrating evidence-based practices and holistic wellbeing approaches Strong skills in crisis intervention, family engagement, and interdisciplinary collaboration. Strong written, verbal and presentation communication skills Microsoft Office and other computer skills Flexible and able to prioritize day-to-day position requirements Strategic thinking with proven ability to communicate a vision and drive results Proficient in analysis and interpretation of clinical data Comfortable with multiple accountabilities and matrix management Proven record of strong relationships and working with diverse teams Demonstrated ability to work independently with excellent judgment Ability to work from home or in a virtual environment Strong interpersonal skills necessary to effectively communicate with medical personnel and members Analytical and problem solving skills necessary to identify and review pertinent information The ability to incorporate analytical data into new or existing clinical programs to enhance quality of care Ability to present data analysis in written format to upper management in a clear, concise manner Ability to maintain a very high level of confidentiality Able to successfully handle competing priorities Experience in the Utilization Review Process which includes Prior-Authorization/Pre-Certification, Retro Reviews, Concurrent Reviews and Post Service Claims Review Experience in the grievance and appeals process and ability to work on escalated issues as they arise Ability to provide quality oversight to personnel, process improvement and policies and procedures Familiarity with National Guidelines such as MCG or InterQual, medical policy or commonly used guidelines from Specialty Colleges Experience in disease management with knowledge and understanding of disease progression. Knowledgeable of the Federal, State and ERISA regulations Qualifications What You Bring to Our Mission QUALIFICATIONS: MD or DO degree and 5+ years of direct clinical patient care experience post residency or fellowship including behavioral health environments. Current and ongoing Board Certification in psychiatry by the American Board of Psychiatry and Neurology (ABPN) required. Additional Board Certification in Child and Adolescent Psychiatry or Addiction Medicine. A current and unrestricted license in the state of California and willing to obtain additional license(s). No current sanction from Federal or State Governmental organizations, and able to pass credentialing requirements. Minimum 5 years of Utilization Review or Hospital experience required. Minimum 3 years of compliance related experience preferred. Managed Care experience preferred in utilization review and case management. Physical and Mental Requirements: Ability to safely and successfully perform the essential job functions with or without a reasonable accommodation, including meeting qualitative and/or quantitative productivity standards. Constant use of computer keyboard and mouse; repetitive use of both hands. Occasional to frequent twisting of neck; occasional bending of neck and at waist. Why You'll Love It Here We believe in total rewards that actually matter-not just competitive packages, but benefits that support how you want to live and work. Your wellbeing comes first: Comprehensive medical and dental coverage through our own health solutions (yes, we use what we build!) Mental health support and wellness programs designed by experts who get it Flexible work arrangements that fit your life, not the other way around Financial security that makes sense: Retirement planning support to help you build real wealth for the future Basic Life and AD&D Insurance plus Short-Term and Long-Term Disability protection Employee savings programs and voluntary benefits like Critical Illness and Hospital Indemnity coverage Growth without limits: Professional development opportunities and clear career progression paths Mentorship from industry leaders who want to see you succeed Learning budget to invest in skills that matter to your future A culture that energizes: People Matter: Inclusive community where every voice matters and diverse perspectives drive innovation One Team One Dream: Collaborative environment where we celebrate wins together and support each other through challenges We Deliver: Mission-driven work that creates real impact on people's health and wellbeing, with clear accountability for results Grow Forward: Continuous learning mindset with team events, recognition programs, and celebrations that make work genuinely enjoyable The practical stuff: Competitive base salary that rewards your success Unlimited PTO policy because rest and recharge time is non-negotiable Benefits effective day one-because you shouldn't have to wait to be taken care of Ready to create a healthier world? We're ready for you. No candidate will meet every single desired qualification. If your experience looks a little different from what we've identified and you think you can bring value to the role, we'd love to learn more about you! Personify Health is an equal opportunity organization and is committed to diversity, inclusion, equity, and social justice. In compliance with all states and cities that require transparency of pay, the base compensation for this position ranges from $189,600 to $237,000. Note that compensation may vary based on location, skills, and experience. This position is eligible for health, dental, vision, mental health and other benefits. We strive to cultivate a work environment where differences are celebrated, and employees of all backgrounds are empowered to thrive. Personify Health is committed to driving Diversity, Equity, Inclusion and Belonging (DEIB) for all stakeholders: employees (at each organization level), members, clients and the communities in which we operate. Diversity is core to who we are and critical to our work in health and wellbeing. #WeAreHiring #PersonifyHealth #TPA #HPA #Selffunded Beware of Hiring Scams: Personify Health will never ask for payment or sensitive personal information such as social security numbers during the hiring process. All official communication will come from a verified company email address. If you receive suspicious requests or communications, please report them to **************************. All of our legitimate openings can be found on the Personify Health Career Site. Application Deadline: Open until position is filled.

The Regional Medical Affairs Director (RMAD) is a member of a field-based team which is an extension of the US Regional Medical Affairs organization and is responsible for developing and enhancing professional relationships with specified key thought-leaders (KTLs), institutions, and organizations in their assigned geographical region. A RMAD focuses on medical & scientific engagement with identified healthcare and decision maker stakeholders by providing medical and scientific support via scientific exchange, addressing customers medical and scientific informational needs, and collaborating in mutually identified areas of medical, education, clinical research, and real-world experience/evidence. RMADs are recognized as an internal subject matter expert and provide appropriate medical and scientific support for internal teams as identified. Candidate to reside in Houston, TX Territory covers: TX, LA, MS Responsibilities Fostering mutually collaborative relationships with institutions, Centers of Excellence, thought leaders (TLs) and key decision makers across the healthcare ecosystem in the areas of medical, education, clinical research, and real world experience. Provide medical information through scientific exchange in a fair-balanced manner and clinical/scientific support as identified or requested in addressing the informational needs of the healthcare community, as well as responding to unsolicited requests for pipeline or off-label information. Delivering medical presentations to diverse healthcare professional (HCP) audiences including healthcare decision makers, professional medical societies, and identified advocacy groups. Providing scientific and liaison support related to Xeris clinical research activity, including thought leader and investigator engagement and follow-up, and facilitation of unsolicited requests for interactions related to Investigator Initiated Studies (IISs). Maintaining cross-functional collaboration with internal & external field teams to provide scientific expertise and medical support within Medical Affairs, Clinical Development, Commercial, and other internal stakeholders, etc. Obtaining, assimilating, organizing, and reporting appropriate competitive and scientific intelligence in a concise, clear manner, compliant with all applicable Xeris policies, procedures, and processes Attending & participating in medical/scientific meetings and conferences for the purpose of gaining scientific insights, collecting emerging scientific data, identifying healthcare trends, and supporting the scientific exchange and communication related to Xeris therapeutic areas of interest and research & development As identified, contribute to internal training for headquarter- and field-based teams and supporting speaker training initiatives. Assisting with the implementation and engagement of TL participation in advisory boards, consultant meetings and other scientific meetings consistent with all Xeris policies, procedures, and processes. Maintain clinical/scientific expertise and providing strategic insights into emerging scientific data and healthcare trends. Collaborating with TLs and Xeris Medical Communications to support the development of appropriate publications and related medical communications. Participate in assigned Medical Affairs projects, initiatives, and activities as identified and requested. Performing and completing administrative responsibilities, including reporting requirements in a timely fashion Qualifications Advanced degree (MD, PhD, PharmD, DNP) in a related discipline strongly preferred Less than 2 years of experience [Entry level as Associate Director]; 2+ years of experience [Entry Level as Director] of previous Field Medical or Medical Affairs pharmaceutical industry [post-doctoral pharmaceutical industry training via residency or fellowship also welcomed] Active clinical care, clinical research, or academia experience preferred Clear understanding of regional medical practice, clinical decision-making and healthcare systems affecting patient care. Demonstrated strong understanding of clinical research trial and/or related laboratory research design and execution Extensive knowledge of Endocrinology, including Cushing's Disease and field medical affairs is strongly preferred. Competencies: Customer Service focus, Teamwork & Collaboration, Written and Verbal Communication skills, Presentation skills, Time Management skills, Self-Starter. Working Conditions: Position may require periodic evening and weekend work, as necessary to fulfill obligations. Periodic overnight travel. Approximately 60% overnight travel The level of the position will be determined based on the selected candidate's qualifications and experience. #LI-REMOTE As an equal employment opportunity and affirmative action employer, Xeris Pharmaceuticals, Inc. does not discriminate on the basis of race, color, religion, sex, gender identity, sexual orientation, national origin, age, disability, veteran status, genetics or any other characteristic protected by law. It is our intention that all qualified applications are given equal opportunity and that selection decisions be based on job-related factors. The anticipated base salary range for this position is $170,000 to $225,000. Final determination of base salary offered will depend on several factors relevant to the position, including but not limited to candidate skills, experience, education, market location, and business need. This role will include eligibility for bonus and equity. The total compensation package will also include additional elements such as multiple paid time off benefits, various health insurance options, retirement benefits and more. Details about these and other offerings will be provided at the time a conditional offer of employment is made. Candidates are always welcome to inquire about our compensation and benefits package during the interview process. NOTE: This job description is not intended to be all-inclusive. Employee may perform other related duties as negotiated to meet the ongoing needs of the organization.

At Caris, we understand that cancer is an ugly word-a word no one wants to hear, but one that connects us all. That's why we're not just transforming cancer care-we're changing lives. We introduced precision medicine to the world and built an industry around the idea that every patient deserves answers as unique as their DNA. Backed by cutting-edge molecular science and AI, we ask ourselves every day: “What would I do if this patient were my mom?” That question drives everything we do. But our mission doesn't stop with cancer. We're pushing the frontiers of medicine and leading a revolution in healthcare-driven by innovation, compassion, and purpose. Join us in our mission to improve the human condition across multiple diseases. If you're passionate about meaningful work and want to be part of something bigger than yourself, Caris is where your impact begins. Position Summary The Senior Medical Director for Multi-Cancer Early Detection (MCED) will serve as a senior physician-executive leader responsible for guiding the medical, scientific, and clinical strategy for Caris' rapidly evolving MCED portfolio. This role provides high-impact medical leadership across clinical development, product innovation, evidence generation, regulatory strategy, and external scientific engagement. The ideal candidate is a nationally recognized physician with substantial experience in oncology, cancer screening, early detection methodologies, and/or molecular diagnostics. This leader will ensure Caris' MCED initiatives are clinically rigorous, patient-centric, and aligned with emerging scientific and regulatory standards. They will collaborate extensively with internal teams-including R&D, Clinical Development, Regulatory, Commercial, and Medical Affairs-as well as external stakeholders, KOLs, investigators, and regulatory bodies. This is a high-visibility role for an executive with deep clinical insight, strategic vision, and exceptional communication and public-facing skills. Job Responsibilities Provide medical, scientific, and clinical expertise for MCED strategy, clinical protocols, regulatory submissions, and study design. Serve as the principal internal medical authority for MCED programs, ensuring scientific rigor and alignment with corporate objectives. Interpret and communicate clinical and analytical performance data, including safety, efficacy, and real-world evidence. Oversee development of scientific publications, abstracts, peer-reviewed manuscripts, and presentations. Partner cross-functionally with Regulatory, Clinical Operations, Biostatistics, R&D, Product, Market Access, and Commercial teams to ensure seamless program execution and clinical relevance. Engage and cultivate relationships with external experts, investigators, clinical partners, advocacy groups, and regulatory agencies. Act as the lead internal physician representing the clinical user experience and real-world clinical workflows for Caris' MCED products. Represent Caris at national and international scientific meetings, advisory boards, and industry forums. Monitor emerging trends in oncology, early detection, liquid biopsy, genomics, biomarkers, and relevant clinical practice guidelines to inform strategy and innovation. Required Qualifications MD (or equivalent) with board certification in oncology, hematology, clinical pathology, or a related specialty. ≥5 years of direct patient care experience, ideally in oncology or a related field with exposure to cancer screening and diagnostic pathways. ≥5 years of experience in clinical development or product development, ideally within oncology diagnostics, screening, or early detection technologies. Demonstrated expertise in biomarker-driven oncology, molecular diagnostics, cancer screening methodologies, or liquid biopsy platforms. Strong understanding of clinical trial design, evidence generation, and regulatory considerations for diagnostic products. Outstanding written and verbal communication skills, with experience presenting to scientific, clinical, and executive audiences. Proven ability to lead in a fast-paced, matrixed environment while managing multiple priorities. Familiarity with health economics, outcomes research, and real-world evidence generation relevant to diagnostic adoption. Preferred Qualifications Direct experience interacting with regulatory authorities (e.g., FDA, EMA) with successful contributions to submissions for diagnostic or screening technologies. Prior leadership experience in industry within diagnostics, biotech, or medtech with focus on oncology or early detection. Established network among oncology KOLs, screening experts, pathology leaders, and/or clinical investigators. Physical Demands Ability to sit or stand for extended periods. Ability to perform repetitive motions. Ability to lift up to 25 pounds. Training All required job-specific, safety, and compliance training will be assigned based on job functions. Other Requirements This role requires frequent travel to scientific conferences, investigator meetings, customer engagements, and internal leadership meetings. Some evening, weekend, and holiday availability may be required. Annual Hiring Range $340,000 - $400,000 Actual compensation offer to candidate may vary from posted hiring range based upon geographic location, work experience, education, and/or skill level. The pay ratio between base pay and target incentive (if applicable) will be finalized at offer. Description of Benefits Highly competitive and inclusive medical, dental and vision coverage options Health Savings Account for medical expenses and dependent care expenses Flexible Spending Account to pay for certain out-of-pocket expenses Paid time off, including: vacation, sick time and holidays 401k match and Financial Planning tools LTD and STD insurance coverages, as well as voluntary benefit options Employee Assistance Program Pet Insurance Legal Assistance Tuition Assistance Conditions of Employment: Individual must successfully complete pre-employment process, which includes criminal background check, drug screening, credit check ( applicable for certain positions) and reference verification. This reflects management's assignment of essential functions. Nothing in this job description restricts management's right to assign or reassign duties and responsibilities to this job at any time. Caris Life Sciences is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender, gender identity, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified individual with disability.

At OrthoVirginia, you are a part of a team dedicated to delivering expert orthopedic and therapy care across the state. As Virginia's largest provider of musculoskeletal care, we offer full-time and part-time opportunities in a collaborative, team-oriented environment. With more than 160 physicians in over 35 locations-including Lynchburg, Northern Virginia, Richmond, Southwest Virginia, and Hampton Roads-OrthoVirginia is a leader in orthopedic surgery, non-surgical care, and physical, hand, and occupational therapy. Our nationally recognized specialists treat a full range of musculoskeletal injuries and conditions, helping patients of all ages move, heal, and thrive. Join us and become part of a trusted network committed to excellence in orthopedic care. The Statewide Orthopedic Urgent Care Physician Leader is responsible for providing strategic and clinical oversight of orthopedic urgent care centers across the state. This role includes ensuring the delivery of high-quality, patient-centered care, optimizing operational performance, and leading a team of clinicians who diagnose and treat a broad range of non-operative musculoskeletal conditions. Key responsibilities include developing and implementing staff training programs, promoting best practices in orthopedic care, and engaging in community outreach to advance musculoskeletal health. The physician leader will also monitor care quality, drive continuous improvement initiatives, and stay current with advancements in non-surgical orthopedic treatment. Additionally, this role will contribute to strategic planning efforts aimed at expanding orthopedic urgent care services into new communities where market demand supports growth. Key Responsibilities: Clinical Oversight: Provide clinical leadership and oversight to ensure the highest standards of orthopedic care are maintained across all urgent care centers. Patient Care: Diagnose and treat a wide range of orthopedic conditions, including fractures, sprains, and other musculoskeletal injuries. Clinician Training: Develop and implement training programs for medical staff to ensure they are up to date with the latest orthopedic practices and protocols, including reading of imaging. Quality Assurance: Monitor and evaluate the quality of care provided, implementing improvements as necessary to maintain compliance with healthcare regulations and standards. Operational Management: Collaborate with operational leaders to ensure efficient operation of all urgent care centers, including scheduling, resource allocation, and patient flow management. Community Outreach: Engage with the community to promote the services offered by the orthopedic urgent care centers and to educate the public on injury prevention and orthopedic health. Research and Development: Stay current with advancements in musculoskeletal care and incorporate new techniques and treatments into practice as appropriate. Business Development: Work with business leadership to evaluate opportunities for expansion of services in new and current markets. Qualifications: Education: Medical degree (MD or DO) from an accredited institution. Licensure: Valid state medical license. Experience: Minimum of 2 years of experience in urgent care medicine with at least 2 years in a leadership or supervisory role. Experience in musculoskeletal urgent care setting a plus. Certifications: Board certification in Orthopedic Surgery, Emergency Medicine, Primary Care or a related specialty. Skills: Strong clinical skills, excellent communication and interpersonal abilities, leadership and management experience, and proficiency in electronic medical records (EMR) systems

Thank you for your interest in joining Solventum. Solventum is a new healthcare company with a long legacy of solving big challenges that improve lives and help healthcare professionals perform at their best. At Solventum, people are at the heart of every innovation we pursue. Guided by empathy, insight, and clinical intelligence, we collaborate with the best minds in healthcare to address our customers' toughest challenges. While we continue updating the Solventum Careers Page and applicant materials, some documents may still reflect legacy branding. Please note that all listed roles are Solventum positions, and our Privacy Policy: *************************************************************************************** applies to any personal information you submit. As it was with 3M, at Solventum all qualified applicants will receive consideration for employment without regard to their race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran. Job Description: Medical Affairs Strategy Director, IP&SS 3M Health Care is now Solventum At Solventum, we enable better, smarter, safer healthcare to improve lives. As a new company with a long legacy of creating breakthrough solutions for our customers' toughest challenges, we pioneer game-changing innovations at the intersection of health, material and data science that change patients' lives for the better while enabling healthcare professionals to perform at their best. Because people, and their wellbeing, are at the heart of every scientific advancement we pursue. We partner closely with the brightest minds in healthcare to ensure that every solution we create melds the latest technology with compassion and empathy. Because at Solventum, we never stop solving for you. The Impact You'll Make in this Role The Medical Affairs Strategy Director for the Infection Prevention & Surgical Solutions (IP&SS) will be the key point of contact between Medical Affairs and the IP&SS leadership team, Corporate Strategy, Regulatory/Quality, and Laboratory leadership to ensure alignment of MA activities with IP&SS global and regional strategies and plans. The leader will own the governance process to ensure a fully integrated Medical Affairs strategy and upstream and downstream activities for the IP&SS portfolio, aligning all Medical Affairs subfunctions and capabilities (evidence plans, scientific exchange, and medical governance & field medical activities, etc.) to ensure therapy adoption to address unmet medical and customer needs while enabling regional adaptation. As the Medical Affairs Strategy Director for IP&SS you will have the opportunity to tap into your curiosity and collaborate with some of the most innovative and diverse people around the world. Here you will make an impact by: Set and maintain the integrated Medical Affairs strategy, by portfolio and area, based on priorities and resourcing. Including Chairing MA strategy reviews; ensure global and regional alignment and trade‑off clarity. Serve as the internal liaison to group leaders in within IP&SS commercial functions, Chief Medical Officer, VP of Strategy and Operations, and all medical affairs sub functions to ensure alignment, prioritization and success Own the Medical Affairs & IP&SS business cadence (monthly/quarterly), including dashboards, decision logs, risk registers, and escalations. Define, track, and continuously improve Medical Affairs KPIs tied to readiness and growth (e.g., publications on plan, MSL readiness/coverage, content cycle‑time, scientific exchange reach/quality, KOL activation). Translate business goals into an evidence roadmap with Clinical Affairs, Scientific Affairs, Medical Directors and Healthcare Economics and Outcomes Research; sequence activities to meet claim/launch objectives Your Skills and Expertise To set you up for success in this role from day one, Solventum requires (at a minimum) the following qualifications: Bachelor's Degree or higher (completed and verified prior to start) AND ten (10) years of experience in the med device, med tech, or pharmaceutical industry Additional qualifications that could help you succeed even further in this role include: Advanced clinical/scientific/business degree from an accredited institution (MD/PhD/PharmD preferred or Master's/MBA Degree with significant Medical Affairs leadership) Five (5) or more years of experience in Medical Affairs/MedTech with multi‑portfolio launch leadership; track record of establishing governance, operating rhythms, and cross‑functional curriculum frameworks that scale. Demonstrated influence at segment/enterprise forums (CRR/portfolio reviews), with proven ability to resolve cross‑functional trade‑offs. Fluency in evidence planning, scientific exchange, compliance fundamentals, KPI design, and change leadership. People leadership experience (direct or large matrix) and budget stewardship for MA strategic initiatives. Work location: Remote - United States Travel: May include up to 30% domestic/international Relocation Assistance: Not authorized Must be legally authorized to work in country of employment without sponsorship for employment visa status (e.g., H1B status). Supporting Your Well-being Solventum offers many programs to help you live your best life - both physically and financially. To ensure competitive pay and benefits, Solventum regularly benchmarks with other companies that are comparable in size and scope. Applicable to US Applicants Only:The expected compensation range for this position is $222,044 - $271,387, which includes base pay plus variable incentive pay, if eligible. This range represents a good faith estimate for this position. The specific compensation offered to a candidate may vary based on factors including, but not limited to, the candidate's relevant knowledge, training, skills, work location, and/or experience. In addition, this position may be eligible for a range of benefits (e.g., Medical, Dental & Vision, Health Savings Accounts, Health Care & Dependent Care Flexible Spending Accounts, Disability Benefits, Life Insurance, Voluntary Benefits, Paid Absences and Retirement Benefits, etc.). Additional information is available at: *************************************************************************************** of this position include that corporate policies, procedures and security standards are complied with while performing assigned duties. Solventum is committed to maintaining the highest standards of integrity and professionalism in our recruitment process. Applicants must remain alert to fraudulent job postings and recruitment schemes that falsely claim to represent Solventum and seek to exploit job seekers. Please note that all email communications from Solventum regarding job opportunities with the company will be from an email with a domain *****************. Be wary of unsolicited emails or messages regarding Solventum job opportunities from emails with other email domains. Please note, Solventum does not expect candidates in this position to perform work in the unincorporated areas of Los Angeles County.Solventum is an equal opportunity employer. Solventum will not discriminate against any applicant for employment on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, or veteran status. Please note: your application may not be considered if you do not provide your education and work history, either by: 1) uploading a resume, or 2) entering the information into the application fields directly. Solventum Global Terms of Use and Privacy Statement Carefully read these Terms of Use before using this website. Your access to and use of this website and application for a job at Solventum are conditioned on your acceptance and compliance with these terms. Please access the linked document by clicking here, select the country where you are applying for employment, and review. Before submitting your application you will be asked to confirm your agreement with the terms.

At Broadway Ventures, we transform challenges into opportunities with expert program management, cutting-edge technology, and innovative consulting solutions. As an 8(a), HUBZone, and Service-Disabled Veteran-Owned Small Business (SDVOSB), we empower government and private sector clients by delivering tailored solutions that drive operational success, sustainability, and growth. Built on integrity, collaboration, and excellence, we're more than a service provider-we're your trusted partner in innovation. The Medical Director serves as the senior clinical authority for the CMS Review and Validation Contractor (RVC) program. This role provides leadership and oversight for all medical review functions, ensuring compliance, clinical accuracy, and alignment with Medicare coverage and payment policy. The CMD must be available to CMS between 8:00 AM and 4:30 PM ET, Monday-Friday, and must be fully dedicated to the RVC contract. Key Responsibilities Oversee all aspects of medical review, validation activities, and quality assurance. Direct clinical personnel on correct application of Medicare policy during the validation process. Participate in CMS discussions, trainings, and policy interpretation sessions. Oversee training and education of RVC medical reviewers. Provide expert guidance on LCDs, NCDs, Medicare manuals, and all applicable medical policies. Serve as an expert resource during complex or questionable claim reviews. Monitor changes in medical practices and technology that may affect billing or improper payment risks. Recommend updates to LCDs, NCDs, system edits, and corrective actions based on RAC-identified vulnerabilities. Participate in CMS/RVC clinical workgroups and presentations as needed. Maintain compliance with conflict-of-interest reporting requirements. Ensure non-medical staff do not perform or oversee tasks requiring clinical judgment. Required Qualifications Experience Minimum 3 years of clinical practice as a board-certified physician with no Medicare sanctions or exclusions. Minimum 2 years of experience in: Health insurance Utilization review Claims processing Medicare or federal healthcare program administration Extensive knowledge of Medicare coverage, billing, and payment rules. Experience working with physician groups, beneficiary organizations, and/or congressional offices preferred. Working knowledge of the CMS Fee-for-Service (FFS) Recovery Audit Program. Education & Licensure Doctor of Medicine (MD) or Doctor of Osteopathy (DO), board-certified. Active, unrestricted license to practice medicine in a U.S. state or territory (verified annually). Core Competencies Expert understanding of Medicare policy, LCDs, NCDs, and clinical review requirements. Strong clinical judgment and analytical skills. Ability to lead, mentor, and direct multidisciplinary review teams. Excellent communication and documentation skills. Professional integrity and ability to make independent, impartial clinical determinations. Work Requirements Full-time, fully dedicated role; may not perform work for other Medicare or non-Medicare contracts without CMS approval. Availability required between 8:00 AM and 4:30 PM ET, Monday-Friday. What to Expect Next: After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with a recruiter to verify resume specifics and discuss salary requirements. Management will be conducting interviews with the most qualified candidates. We perform a background and drug test prior to the start of every new hires' employment. In addition, some positions may also require fingerprinting. Broadway Ventures is an equal-opportunity employer and a VEVRAA Federal Contractor committed to providing a workplace free from harassment and discrimination. We celebrate the unique differences of our employees because they drive curiosity, innovation, and the success of our business. We do not discriminate based on military status, race, religion, color, national origin, gender, age, marital status, veteran status, disability, or any other status protected by the laws or regulations in the locations where we operate. Accommodations are available for applicants with disabilities.

We are seeking a Nephrologist- Medical Director to join our dynamic team. The Medical Director will have overall responsibility for providing medical, scientific, and strategic leadership for the successful planning, execution, and reporting of clinical trials. Additionally, this role acts as the Medpace internal medical expert and will serve as a medical resource for the review, presentation, and interpretation of results in the Clinical Study Report. The Medical Director will also be involved in the development of new clinical projects, including study design, protocol, and project plans as required. We are currently seeking Medical Directors in all Therapeutic Areas. All Medical Directors have hybrid WFH flexibility. This role also has the ability to be fully remote with the right experience. Responsibilities * Provide medical management and expertise for clinical trials; * Contribute medical expertise to study reports, regulatory documents, and manuscripts; * Manage safety issues in clinical trials and work closely with associates in evaluation and assessment of the trials; * Participate in new business development through involvement in proposal and sponsor meetings as requested; * Coordinate with other departments in all phases of the studies and trials including feasibility assessments, design processes, educational efforts, management of medical information, and reviewing and editing of medical documents; * Follow specific research related protocol and lead others in strict adherence to the policies. Qualifications * Must have an M.D., specialization in Nephrology * Must be eligible to obtain a medical license * Board certification preferred * Prior clinical trial research experience preferred * Previous experience in pharmaceutical-related clinical research is preferred. Travel: up to 20% Medpace Overview Medpace is a full-service clinical contract research organization (CRO). We provide Phase I-IV clinical development services to the biotechnology, pharmaceutical and medical device industries. Our mission is to accelerate the global development of safe and effective medical therapeutics through its scientific and disciplined approach. We leverage local regulatory and therapeutic expertise across all major areas including oncology, cardiology, metabolic disease, endocrinology, central nervous system, anti-viral and anti-infective. Headquartered in Cincinnati, Ohio, employing more than 5,000 people across 40+ countries. Why Medpace? People. Purpose. Passion. Make a Difference Tomorrow. Join Us Today. The work we've done over the past 30+ years has positively impacted the lives of countless patients and families who face hundreds of diseases across all key therapeutic areas. The work we do today will improve the lives of people living with illness and disease in the future. Cincinnati Perks * Cincinnati Campus Overview * Flexible work environment * Competitive PTO packages, starting at 20+ days * Competitive compensation and benefits package * Company-sponsored employee appreciation events * Employee health and wellness initiatives * Community involvement with local nonprofit organizations * Discounts on local sports games, fitness gyms and attractions * Modern, ecofriendly campus with an on-site fitness center * Structured career paths with opportunities for professional growth * Discounted tuition for UC online programs Awards * Named a Top Workplace in 2024 by The Cincinnati Enquirer * Recognized by Forbes as one of America's Most Successful Midsize Companies in 2021, 2022, 2023 and 2024 * Continually recognized with CRO Leadership Awards from Life Science Leader magazine based on expertise, quality, capabilities, reliability, and compatibility What to Expect Next A Medpace team member will review your qualifications and, if interested, you will be contacted with details for next steps.

The Medical Director is responsible for supporting staff by providing training, clinical consultation, and clinical case review for members. Essential Functions: Provide prior authorization medical reviews, consultation and clinical review services Participate in peer-to-peer discussions Provide provider education, training, data sharing, performance evaluations and orientation to the plan Conduct clinical reviews for designated CareSource members as requested Provide physician review for clinical appeals cases Participate in the evaluation and investigations of cases suspected of fraud, abuse, and quality of care concerns Participate in development of policies and procedures Participates in quality improvement initiatives, case management activities and member safety activities (i.e. incident management Provide cross-coverage for other Medical Directors and/or markets, as needed Oversight and quality improvement activities associated with case management activities Assist in the review of utilization data to identify variances in patterns, and provide feedback and education to MCP staff and providers as appropriate Participate in the development, implementation and revision of the clinical care standards and practice guidelines ensuring compliance with nationally accepted quality standards Participate in the development, implementation and revision of the Quality Improvement Plan and corporate level quality initiatives Collaborate with market/product leaders to help define market strategy Community collaborative participation Support of regulatory and accreditation functions (eg. CMS, State, NCQA and URAC) and compliance for all programs Perform any other job related instructions, as requested Education and Experience: Completion of an accredited Medical Degree program as a medical doctor (MD) or Doctor of Osteopathic (DO) medicine is required Successful completion of a residency training program, preferably in primary care is required Minimum of five (5) years of clinical practice experience is required Managed care medical review/medical director experience is preferred Bachelor's or Master's degree in Business Administration, Operational Excellence, Healthcare Administration or Medical Management is preferred Competencies, Knowledge and Skills: Basic Microsoft Word skills Excellent communication skills, both written and oral Ability to work well independently and within a team environment Ability to create strong relationships with Providers and Members High ethical standards Attention to detail Critical listening and systematic thinking skills Ability to maintain confidentiality and act in the company's best interest Ability to act with diplomacy and sensitivity to cultural diversity Decision making/problem solving skills Conflict resolution skills Strong sense of mission and commitment of time, effort and resources to the betterment of the communities served Licensure and Certification: Current, unrestricted license to practice medicine in state of practice as necessary to meet regulatory requirements is required Board Certification, preferably in primary care specialty is required Re-certification, as required by specialty board, must be maintained (exceptions may be granted by Chief Medical Officer) MCG Certification is required or must be obtained within six (6) months of hire Working Conditions: General office environment; may be required to sit or stand for extended periods of time May be required to work evenings/weekends May be required to travel to fulfill duties of position Compensation Range: $191,400.00 - $334,900.00 CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package. Compensation Type (hourly/salary): Salary Organization Level Competencies Fostering a Collaborative Workplace Culture Cultivate Partnerships Develop Self and Others Drive Execution Influence Others Pursue Personal Excellence Understand the Business This is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.#LI-SW2

Required licensure: TX, KY, FL, WA licenses are preferred The Behavioral Health Physician will serve as an independent contractor providing physician-level utilization management (UM) services for behavioral health services. This role is non-clinical and limited exclusively to medical necessity determinations, peer-to-peer reviews, and appeals in accordance with applicable regulations, accreditation standards, and plan policies. Scope of Services The Contractor will perform UM activities including, but not limited to: Initial Medical Necessity Reviews for behavioral health services requiring physician-level determination Concurrent Reviews for continued authorization of services Peer-to-Peer (P2P) Reviews with treating providers Appeals Reviews, including first- and second-level determinations, as applicable Issuance of adverse determinations when clinically indicated, ensuring compliance with federal and state regulations, parity requirements, and plan policies Documentation of determinations in UM systems with clear clinical rationale and supporting criteria Participation in quality improvement processes related to UM decisions, as requested Exclusions / Non-Scope This role does not include: Direct patient care or treatment Prescribing services Care coordination or case management Administrative leadership or supervisory responsibilities Clinical Expertise & Requirements MD or DO with board certification in Psychiatry (required) Active, unrestricted medical license in applicable state(s) of review Experience in behavioral health utilization management, preferably in managed care or health plan settings Demonstrated knowledge of: Medical necessity criteria (e.G., MCG, InterQual, or equivalent) Federal and state behavioral health regulations MHPAEA requirements NCQA and CMS standards Strong peer-to-peer communication skills Work Expectations Remote work environment Flexible scheduling based on case volume and turnaround time requirements Ability to meet required regulatory and contractual decision timelines Maintain confidentiality and comply with HIPAA and data security standards Reporting & Oversight Operates independently while adhering to health plan UM policies, delegated authority parameters, and medical policy Subject to audit, quality oversight, and performance monitoring consistent with UM regulatory requirements

Job DescriptionMEDICAL DIRECTOR - REMOTE ARC Group has an immediate opportunity for a Medical Director! This position is 100% remote working eastern time zone business hours. This is a direct hire FTE position and a fantastic opportunity to join a well-respected organization and have a positive impact on the lives of millions of people. At ARC Group, we are committed to fostering a diverse and inclusive workplace where everyone feels valued and respected. We believe that diverse perspectives lead to better innovation and problem-solving. As an organization, we embrace diversity in all its forms and encourage individuals from underrepresented groups to apply. 100% REMOTE! Candidates must currently have PERMANENT US work authorization. Sorry, but we are not considering any candidates from outside companies for this position (no C2C, 3rd party / brokering). SUMMARY STATEMENT The Medicare Contractor Medical Director (CMD) provides medical leadership and decision making for an organization that serves as a Medicare Administrative Contractor (MAC). This role serves as a liaison between the Centers for Medicare and Medicaid Services (CMS) and stakeholders. CMDs play a vital role in developing Local Coverage Determinations (LCDs) and ensuring compliance with Medicare policies, reviewing medical claims, and promoting evidence-based healthcare. ESSENTIAL DUTIES & RESPONSIBILITIES Clinical Expertise and Consultation 30% Provide leadership in clinical program outreach to the practitioner/provider/supplier/beneficiary community. Provide direction and assistance to clinical staff in conducting provider education, as well as assist in the development of clinical guidelines as needed. Keep clinical knowledge up to date and abreast of medical practice and technology changes. Serve as a subject matter expert in medical and clinical areas relevant to the Medicare program. Provide clinical consultation to internal teams (e.g., medical review staff, appeals teams) and external stakeholders. Provide the clinical expertise, scientific literature analysis, claims data analytics to effectively focus medical polical policy and reviews on identified problem areas. Collaboration and Leadership 30% Collaborate with CMS and other Medicare Contractors (e.g., A/B or DME MACs and others) to develop and update medical policies and articles based on clinical evidence and regulatory requirements. Work with multidisciplinary teams within the MAC to improve processes and ensure compliance with CMS directives. Liaise with CMS staff, medical societies, and other stakeholders to align goals and address emerging issues. Represent the MAC at CMS meetings and industry conferences. Strengthen the quality improvement procedures with emphasis on decision consistency and clinical education of clinical staff through various mechanisms including but not limited to overseeing Inter-Reviewer Reliability (IRR) reviews. Program Integrity 20% Support program integrity initiatives, including identifying trends in inappropriate billing practices or noncompliance. Ensure the proper application of Medicare regulations, national and local coverage determinations (NCDs and LCDs), and clinical guidelines. Participate in all phases of LCD development by leading the Local Coverage Determination (LCD) process to include development, revision, retirement, education, and decision making. Collaborate with investigative teams and law enforcement when required. Medical Review (MR) and Appeals 10% Oversee medical review activities to ensure appropriate and consistent decisions on claim determinations including pre- and post-payment determinations. Provide leadership in developing and implementing MR Quality Assurance Programs. Provide leadership in effectively focusing MR and developing internal MR guidelines. Review complex or high-level appeals and provide guidance on the application of Medicare policies. Provide support to the claim appeal process including assistance in the development of position papers and participation in the administrative process when needed such as Administrative Law Judge (ALJ) hearings. Provider Education and Communication 10% Provide leadership in the provider community (including interacting with hospital/specialty associations). Educate providers, individually or as a group, regarding identified problems or medical policy. Maintain Professional and Organization Relationships Performs other duties as the supervisor may, from time to time, deem necessary. Travel within and outside the assignedjurisdictions, as needed. Expected to be no more than 3-4 weeks/year but could vary based on business needs. REQUIRED QUALIFICATIONS MD or DO degree from accredited Medical School Minimum of three years clinical practice experience as an attending physician Extensive knowledge of the Medicare program, particularly the coverage and payment rules Work experience in the health insurance industry, a utilization review firm, or another health care claims processing organization in a role that involved developing coverage or medical necessity policies and guidelines. Knowledge, skill, and experience to evaluate clinical evidence, and to develop evidence-based medical necessity standards within the Medicare fee-for-service benefit structure Ability to develop strategies and processes to ensure evidence-based decision-making for policy in the Medicare population Basic understanding of medical coding conventions Ability to effectively communicate, collaborate with, and provide education on health care policy issues to both internal team members and external entities Ability to work collaboratively with internal staff to evaluate aberrancies, determine appropriate billing, coding, pricing, and utilization of services Proficiency with effective public speaking and ability educate providers Ability to work collaboratively with clinical and non-clinical team members Ability and desire to educate team members and external entities (i.e., CMS, providers, other federal agencies, law enforcement, etc.) Computer literacy, including proficiency using word processing, spreadsheets, presentation, and virtual meeting applications Ability to complete independent or computer-based training and education Certifications, Licenses, Registration: Current, active, valid, unrestricted license to practice medicine in at least one state or territory within the United States, never suspended or revoked in any state or territory of the United States Eligible for licensure within jurisdiction of enterpriseoperations Board Certified Doctor of Medicine or a Doctor of Osteopathy in a specialty recognized by the American Board of Medical Specialties for at least three years PREFERRED QUALIFICATIONS Experienced Physical Medicine and Rehabilitation (PM&R), Oncology, Radiology, Ophthalmology or Infectious Diseases professionals with five years of clinical practice MBA, MHA, MS in Management, or formal accredited coursework in medical systems management Demonstrated successful working experience in organized medicine group(s) (e.g., AMA, specialty society, state health department) as a committee chairperson or other leadership Medical Director experience in Medicare-related or commercial healthcare organization Coding and billing experience utilizing HCPCs, CPT, and ICD-10 codes Experience using GRADE methodology for literature analysis and performing systematic reviews Experience working with physician groups, beneficiary organizations, and/or congressional offices Would you like to know more about our new opportunity? For immediate consideration, please send your resume directly to John Burke at ******************** or apply online while viewing all of our open positions at ******************* ARC Group is a Forbes-ranked a top 20 recruiting and executive search firm working with clients nationwide to recruit the highest quality technical resources. We have achieved this by understanding both our candidate's and client's needs and goals and serving both with integrity and a shared desire to succeed. At ARC Group, we are committed to providing equal employment opportunities and fostering an inclusive work environment. We encourage applications from all qualified individuals regardless of race, ethnicity, religion, gender identity, sexual orientation, age, disability, or any other protected status. If you require accommodations during the recruitment process, please let us know. Position is offered with no fee to candidate.

Who We Are BioMarin is a global biotechnology company that relentlessly pursues bold science to translate genetic discoveries into new medicines that advance the future of human health. Since our founding in 1997, we have applied our scientific expertise in understanding the underlying causes of genetic conditions to create transformative medicines, using a number of treatment modalities. Using our unparalleled expertise in genetics and molecular biology, we develop medicines for patients with significant unmet medical need. We enlist the best of the best - people with the right technical expertise and a relentless drive to solve real problems - and create an environment that empowers our teams to pursue bold, innovative science. With this distinctive approach to drug discovery, we've produced a diverse pipeline of commercial, clinical and preclinical candidates that have well-understood biology and provide an opportunity to be first-to-market or offer a substantial benefit over existing therapeutic options. About Worldwide Research and Development From research and discovery to post-market clinical development, our WWRD engine involves all bench and clinical research and the associated groups that support those endeavors. Our teams work on developing first-in-class and best-in-class therapeutics that provide meaningful advances to patients who live with genetic diseases. BioMarin Clinical Science (CLS) is responsible for overseeing clinical programs across various phases, from proof-of concept to Phase 3 and BLA/NDA/MAA filing. The Clinical Science team provides leadership for clinical strategy and oversight to ensure excellence in clinical trial conduct, data analysis and interpretation, publication preparation, and safety monitoring BioMarin Clinical Science (CLS) is responsible for overseeing clinical programs across various phases, from proof-of concept to Phase 3 and BLA/NDA/MAA filing. The Clinical Science team provides leadership for clinical strategy and oversight to ensure excellence in clinical trial conduct, data analysis and interpretation, publication preparation, and safety monitoring. Summary Description: Fully remote role - US based candidates The Medical Director has a key scientific and analytical leadership role in the development of CLS core deliverables across study planning, design and execution, results analysis and regulatory filings. Key focus areas include: acting as a study Medical Monitor and providing the scientific input into the creation and review of all CLS study deliverables and monitoring subject eligibility, study data and contributing critically to the scientific interpretation and integration of clinical study results.The Medical Director will also contribute to the scientific strategy and plan as outlined in the Clinical Development Plan (CDP). The Medical Director is also responsible for providing medical input into the creation and review of all CLS study deliverables to support clinical decision making, problem solving, and safety surveillance, as well as collaboration with external physician stakeholders. Key Responsibilities: Scientific Leadership Support the definition of the core clinical and scientific strategy that serves as the basis for the CDP and provide CLS expertise in the design and execution of clinical studies under the purview of the CDP Participate (as assigned) in the development of CLS-assigned sections of regulatory filings and in drafting regulatory responses in collaboration with Medical Writing Establish relationships with investigators and KOLs as appropriate in support of the CDP Stay up to date with advances in literature in therapeutic/disease area including mechanism of action, diagnostic tests, treatment, drug development trends, and regulatory requirements Develop therapy-specific publication plans and work with internal and external colleagues to prepare study results for timely publication Attend and contribute to relevant scientific conferences, seminars or presentations Clinical Study Planning and Monitoring Act as the scientific subject matter expert, and primary contact, for assigned clinical study; take a proactive approach to identifying issues and mitigating risk Initiate and provide the medical and scientific content and insight for development and review of: protocols, protocol amendments; ICFs; CRFs; statistical tables and listings including accurate AE (MedDRA) and concomitant medications (WHODrug) coding; audit reports; clinical study reports; inspection readiness activities, regulatory submissions and other key study deliverables Provide clinical input to statistical analysis plan to ensure alignment with Regulatory and business interests Facilitate the review and approval of all study related CLS deliverables and content Act as study scientific subject matter expert and main point of contact for Principal Investigators (PIs) and sites to assess subject eligibility, provide scientific rational and manage ongoing protocol issues Provide leadership to sites by developing or participating in training, answering investigator/site questions about the protocol Respond to site and Health Authority questions about the protocol Conduct periodic review of protocol deviations in collaboration with Clinical Operations Study Lead or designee (per protocol specific Protocol Deviation Plan) Attend and present at Investigator Meetings, as needed Conduct data review, assessment and interpretation of clinical data to ensure that the data are correct and presented with the appropriate interpretation including thorough review of SAEs and other important AEs (per the study specific Medical Monitoring Plan) Review and analyze SAEs, safety and efficacy trends on an ongoing basis Work closely with the Pharmacovigilance representatives providing medical input into safety reports including, SAE narratives and analysis of similar events, Development Safety Update Reports (DSURs) and Suspected Unexpected Serious Adverse Reactions (SUSARs) reports, Company Core Safety Information (CCSI), Investigator Brochure (IB), Risk Management Plans, Integrated Summaries of Safety and Efficacy, Clinical Study Reports and preparation of labels Participate in and provide scientific advice, as appropriate, during key Database Lock (DBL) activities (final listing review, review of blinded tables, listings and figures (TLFs), etc.) and actively participate in all data snapshots taken (not limited to final DBL) Collaborate with Biometrics to identify key issues, prepare content and facilitate discussions at study Data Review Board (internal) or Data Monitoring Committee (DMC) Lead the selection of and interactions with independent Data Monitoring Committees (DMC) The Medical Director will also act as the medical subject matter expert for review of clinical and safety data to ensure data are correct and presented with the appropriate medical interpretation and for discussing safety concerns with sites Governance and Communication Provide timely and high-quality functional deliverables and contributions to Study Execution Team (SET) Act as primary point of contact between SET and BCLS to ensure appropriate dissemination of information and communication (including functional managers and other relevant individuals) Provide agenda topics to be discussed during SET meetings Act as the medical and scientific subject matter expert (SME) to the SET with the ability to make decisions and recommendations on behalf of BCLS Proactively identify and communicate potential risks and mitigations relevant to the BCLS deliverables Contribute to the development and maintenance of study- specific plans; manage the development of study-specific plans that are the responsibility of BCLS Collaborate with BCLS Therapeutic Area Lead, CDTL and CSL on all study related decisions, as appropriate Escalate issues affecting BCLS function deliverable quality, timelines, resources or budget, as appropriate Competencies The Medical Director is expected to exhibit mastery-level understanding of multiple technical competencies, including scientific knowledge, data analysis, and scientific writing. S/he should also have advanced-level competence in several areas, including strategic thinking and problem solving. The Medical Director should: Identify scientific and medical knowledge gaps in therapeutic area and target populations to drive research and publication strategies Assess the clinical and medical impact of clinical and external research findings and data on overall therapeutic area and clinical development strategies Conduct comprehensive document evaluations including evaluation of statistical presentations, research methods, quality and completeness of content Identify internal and external best practices, trends, developments or alternative approaches that can be leveraged for strategy development Demonstrate ability to look beyond the obvious toward innovative approaches, avoiding biases and historical crutches The Medical Director will also demonstrate mastery of relevant clinical and therapeutic area knowledge to support clinical decision making, problem solving, safety surveillance, and as well as collaboration with external physician stakeholders. Education and Experience: MD, MD/PhD (or equivalent) Advanced degree in life or health sciences (e.g. PhD/PharmD/RN) 5 or more years of relevant experience in Clinical Development, with experience in genetic diseases, specialty care, and/or rare diseases desired; Clinical experience preferred Note: This description is not intended to be all-inclusive, or a limitation of the duties of the position. It is intended to describe the general nature of the job that may include other duties as assumed or assigned. Equal Opportunity Employer/Veterans/Disabled An Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status and will not be discriminated against on the basis of disability.

Site: Mass General Brigham Health Plan Holding Company, Inc. Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham. Job Summary Mass General Brigham Health Plan is an exciting place to be within the healthcare industry. As a member of Mass General Brigham, we are on the forefront of transformation with one of the world's leading integrated healthcare systems. Together, we are providing our members with innovative solutions centered on their health needs to expand access to seamless and affordable care and coverage. Our work centers on creating an exceptional member experience - a commitment that starts with our employees. Working with some of the most accomplished professionals in healthcare today, our employees have opportunities to learn and contribute expertise within a consciously inclusive environment where diversity is celebrated. We are pleased to offer competitive salaries, and a benefits package with flexible work options, career growth opportunities, and much more. Under the direction of the Senior Medical Director, the Medical Director leads as a senior physician at the health plan. This position works closely with the Senior Medical Director in providing medical management leadership for clinical services operations and programs. This role focuses on and has expertise in utilization management, health plan quality and accreditation, care management, and other health plan functions. Qualifications Licensure and Credentials: Must maintain an active full physician license in Massachusetts Experience: * 3-5 years of Health Plan experience * at least 5 years of clinical practice experience Job Duties: Handles utilization management initial determinations, appeals and grievances within the scope of their expertise as defined by Medicare, MassHealth, NCQA and the Division of Insurance and within the compliance requirements of key regulatory and accreditation entities * Reviews clinical services and quality incidents when sufficiently serious to merit physician involvement * Coverage of medical necessity determinations to support special investigations/fraud waste and abuse cases * Collaborates on health plan medical policy development * Assesses new, emerging, and existing technologies to determine appropriateness of health plan coverage * Partners with clinical leaders to ensure medical service expenditures remain within budget * Collaborates with business development, quality, finance and medical management teams to promote improvements in the quality and cost efficiency of care throughout the MGB Health Plan provider network * Delivers consultation to network management staff and deployment of education programs for network clinicians * Develops and delivers presentations for clinical staff on current topics relevant to MGB Health Plan members and network * May represent MGB Health Plan at a variety of external forums and committees * Interact, communicate and collaborate with network and community physicians, hospital leaders and other vendors regarding care and services for enrollees * Monitors performance metrics and audits to identify areas for continuous improvement and ensure compliance * Anticipates and meets or exceeds internal and/or external customer expectations and requirements; establishes and maintains positive relationships with customers and gains their trust and respect * Build strong relationships and infrastructure that designate MGB Health Plan as a people-first organization * Ensure diversity, equity and inclusion are integrated as a guiding principle * Other duties as assigned with or without accommodation Additional Job Details (if applicable) Primarily remote position, exempt * In person meetings as requested for business needs * Participates in after hours and weekend call rotation as assigned Remote Type Remote Work Location 399 Revolution Drive Scheduled Weekly Hours 40 Employee Type Regular Work Shift Day (United States of America) EEO Statement: Mass General Brigham Health Plan Holding Company, Inc. is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veteran's Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants who require accommodation in the job application process may contact Human Resources at **************. Mass General Brigham Competency Framework At Mass General Brigham, our competency framework defines what effective leadership "looks like" by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.

The Division of Pediatric Cardiology at Inova LJ Murphy Children's Hospital is seeking a full-time Pediatric Cardiologist to serve as Medical Director of Non-Invasive Cardiovascular Imaging to support our rapidly growing team within Inova Children's Heart Center. The Heart Center at Inova LJ Murphy Children's Hospital has been caring for the children of Northern Virginia and the Greater Washington Region for more than 30 years. Each year, the program is responsible for approximately 550 procedures. The program provides surgical repair of the most complex congenital heart defects, including hypoplastic left heart syndrome. In addition to providing care for children with complex congenital anomalies, the program provides a lifetime of care as part of the Inova Schar Heart and Vascular, which includes the Adult Congenital Program. Inova Children's Heart Center is a comprehensive team, including congenital cardiac surgery, outpatient cardiology, fetal cardiology, non-invasive cardiology, adult congenital cardiology, diagnostic and interventional catheterization, and electrophysiology and advanced heart failure therapies. The team includes 23 board-certified pediatric cardiologists, 8 pediatric cardiac intensivists, 3 pediatric cardiac surgeons and 17 advanced practice providers. With respect to non-invasive imaging, the division currently performs fetal, transthoracic, and transesophageal echocardiography, and partners with radiology on cMRI and CT scans. A team of inpatient and outpatient dedicated congenital sonographers support the division. The Pediatric Noninvasive Imaging Lab (ICAEL accredited) at Inova Children's Hospital is the largest program in Virginia performing 11,000 outpatient and 2,600 inpatient echocardiograms per year. Inova LJ Murphy Children's Hospital is a 226-bed children's hospital at Inova Fairfax Hospital medical campus, located in Northern Virginia. As the only dedicated children's hospital and pediatric heart center in Northern Virginia, we provide care in a welcoming environment that offers the latest in technical innovation in kid-friendly spaces. The children's hospital has a 108-bed, level IV Neonatal Intensive Care Unit with approximately 17,000 annual deliveries. The Pediatric Cardiac Intensive Care Unit and Acute Cardiac Care Unit are part of the Inova Children's Heart Center. Inova is consistently ranked as a national healthcare leader in safety, quality and patient experience. We are also proud to be consistently recognized as a top employer in both the D.C. metro area and the nation. Featured Benefits: Physician Led Organization: Potential for Physician leadership opportunities Committed to Team Member Health: Offering medical, dental and vision coverage, and a robust team member wellness program. Competitive Compensation Package: Competitive Base and Incentive program with opportunities for Sign-On, Retention, and Relocation bonuses Retirement: Inova matches the first 5% of eligible contributions - starting on your first day. 457B retirement plan is also available for physicians in a 0.5 FTE and greater CME Support: Up to $3,500 a year for CME support and up to 5 days of CME Tuition and Student Loan Assistance: offering up to $5,250 per year in education assistance and up to $10,000 for student loans. Work/Life Balance: offering paid time off and paid parental leave Medical Director, Pediatric Non-Invasive Cardiovascular Imaging Job Responsibilities: Support and mentor junior and mid-career pediatric cardiology echo attendings within the Pediatric Heart Center. Support and mentor ultrasound technicians within the Pediatric Heart Center. The candidate should have advanced training in non-invasive imaging while possessing professional, clinical, and leadership skills. This position will work with the Chief of Pediatric Cardiology and the leadership of the Inova Children's Heart Center to execute yearly personal and programmatic goals focused on the fundamentals of extraordinary care: Safety, quality, patient experiences, access, and stewardship. This is a perfect position for the candidate that thrives in an environment that focuses on teamwork, collaboration and dedication to patients, families, and each other. Although patient care is our primary focus, education and research are also encouraged and supported with access to dedicated research professionals including statisticians, research manager, and research coordinators. Professional responsibilities will include directing noninvasive imaging for the Pediatric Heart Center. Minimum Qualifications: Education: Doctorate Medicine MD or DO (completion of USMLE if non-US education) Training: Successful completion of physician residency program. Pediatric/Congenital Advanced Cardiac Imaging Fellowship Certification: Board eligible or Board Certified in Pediatric Cardiology. Licensure: Physician Upon Start; Current unrestricted license to practice medicine in the State of Virginia. Preferred Qualifications: The ideal candidate will have extensive experience (5+ years) in the field, specifically in echocardiography (TTE, TEE, strain analysis and 3D imaging) Preference will be given to those with experience at higher-volume centers and demonstrated leadership roles in imaging. The ideal candidate will have prior experience or education in medical administration, with preference given to those who also possess clinical research experience.