Medical Director jobs at Providence Community Health Centers

**Your Future Evolves Here** Evolent partners with health plans and providers to achieve better outcomes for people with most complex and costly health conditions. Working across specialties and primary care, we seek to connect the pieces of fragmented health care system and ensure people get the same level of care and compassion we would want for our loved ones. Evolent employees enjoy work/life balance, the flexibility to suit their work to their lives, and autonomy they need to get things done. We believe that people do their best work when they're supported to live their best lives, and when they feel welcome to bring their whole selves to work. That's one reason why diversity and inclusion are core to our business. Join Evolent for the mission. Stay for the culture. **What You'll Be Doing:** Job Description **Cardiovascular Utilization Management Reviewer (Interventional Cardiologist)** Are you ready to make a meaningful impact on patient care in a non-clinical setting? Join our Utilization Management team as a Field Medical Director, Cardiovascular Specialist and use your expertise in interventional cardiology to help ensure the delivery of high-value, evidence-based case reviews. Enjoy improved work-life balance while contributing to better health outcomes in an environment that fosters collaboration, continuous learning, and impactful peer-to-peer discussions. **What We Offer:** + A meaningful way to contribute to patient care beyond the clinical setting. + Opportunities for collaboration with a dynamic team of physicians, leaders, and clinical professionals. + A role that values innovation, continuous improvement, and clinical excellence. + **This position is 100% Remote and can be completed from any state. Multiple opportunities for a flexible schedule and both part-time and full-time options available.** **What You'll Do:** + Provide expert reviews for cardiovascular cases, serving as a specialty-matched expert reviewer for invasive/interventional cardiology cases (e.g., cardiac catheterizations, coronary interventions, endovascular procedures, implantable cardiac devices, etc) that do not initially meet medical necessity guidelines or require further evaluation by a subject matter expert. + Conduct peer-to-peer discussions with treating providers to ensure appropriate, high-value care aligned with clinical guidelines. + Collaborate with leadership, management, and clinical staff to address complex cases and support decision-making. + Act as a key resource for Initial Clinical Reviewers, offering guidance and expertise to ensure the application of best practices. + Provides clinical rationale for standard and expedited appeals. + Discusses determinations (peer to peer phone calls) with requesting physicians or ordering providers, when available, within the regulatory timeframe of the request. + Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD review process to reflect appropriate utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance (NCQA) guidelines. + Ensures documentation of all communications with medical office staff and/or MD provider is recorded in a timely and accurate manner. + Participates in on-going training per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. + On a requested basis, may function as Medical Director for selecting health plans or regions, assuming overall accountability for utilization management while working in conjunction with the Senior Medical Director. **Qualifications** + MD/DO/MBBS Degree + Current, unrestricted clinical license in medicine or required specialty + Obtaining and maintaining medical licenses in the state you reside, as well as, other state licensure required per business needs + Active Board Certification in Interventional Cardiology **or** may be substituted for one of the following: + Active Board Certification in Cardiology **and** proof of prior board certification in Interventional Cardiology + Active Board Certification in Cardiology **and** proof of active practice as an Interventional Cardiologist for 5+ years + Strong clinical, management, communication, and organizational skills + Energetic and curious with a passion for quality and value in health care + Computer Proficiency + Minimum of five (5) years' experience in the practice of Cardiology is preferred + Not under current exclusion or sanction by any state or federal health care program, including Medicare or Medicaid, and is not identified as an "excluded person" by the Office of Inspector General of the Department of Health and Human Services or the General Service Administration (GSA), or reprimanded or sanctioned by Medicare. + No history of a major disciplinary or legal action by a state medical board To ensure a secure hiring process we have implemented several identity verification steps, including submission of a government issued photo ID. We conduct identity verification during interviews, and final interviews may require onsite attendance. All candidates must complete a comprehensive background check, in-person I-9 verification, and may be subject to drug screening prior to employment. The use of artificial intelligence tools during interviews is prohibited and monitored. Misrepresentation will result in immediate disqualification from consideration. **Technical Requirements:** We require that all employees have the following technical capability at their home: High speed internet over 10 Mbps and, specifically for all call center employees, the ability to plug in directly to the home internet router. These at-home technical requirements are subject to change with any scheduled re-opening of our office locations. **Evolent is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, or disability status.** **If you need reasonable accommodation to access the information provided on this website, please contact** ************************** **for further assistance.** The expected base salary/wage range for this position is $120-$140/hr. This position is also eligible for a bonus component that would be dependent on pre-defined performance factors. As part of our total compensation package, Evolent is proud to offer comprehensive benefits (including health insurance benefits) to qualifying employees. All compensation determinations are based on the skills and experience required for the position and commensurate with experience of selected individuals, which may vary above and below the stated amounts. Don't see the dream job you are looking for? Drop off your contact information and resume and we will reach out to you if we find the perfect fit!

This role supports the Medical Policy team by bringing medical director level expertise, experience and knowledge to the team. They support the full-cycle ownership of commercial and Medicare Advantage medical policies, both developed internally and by vendors. This includes the writing of clinical criteria based on research, engagement of clinical and non-clinical team members for operational guidelines. The incumbent must have an understanding of medical coding (ICD-10, CPT, HCPS) as medical coding based off policy criteria falls within their scope. In addition to developing new policies, the incumbent ensures all existing medical policies, in their scope, are in accordance with NCQA and/or CMS requirements. The incumbent may be required to address escalated inquiries brought forward by internal/external partners. Conducts peer reviews as part of the quality review process. In addition to policy ownership, the incumbent participates in various work-groups and sub-committees as a clinical lead/expert. Trains and orients new staff to the department and policy procedures, and mentors new team members. Serves as a liaison between other departments and vendors as required. **ESSENTIAL RESPONSIBILITIES** + Full-cycle ownership of commercial and Medicare Advantage medical policy creation process including writing clinical criteria and oversight/ownership of the clinical presentations to committees for internally developed and vendor owned policies.Engage other departments, team members, strategic partners, and vendors to assist with research. + Provide clinical guidance to non-clinical team.This may include those who own Medicare Advantage policy updates, and those who support the commercial policy team. + Address escalated policy inquiries that require clinical expertise.This may include updating/revising existing medical policies. + Partner with Utilization Management and other operational teams to identify opportunities within medical policy. + Discover and cultivate innovative opportunities that drive significant improvements in healthcare quality and efficiency. + Other duties as assigned or requested. **EXPERIENCE** **Required** + 5 years of Active medical practice + 3 years of medical policy experience **Preferred** + 1 year of medical coding experience **SKILLS** + Critical Thinking + Oral and Written Communication + Listening + Telephone Skills + General Computer Skills, including Excel + Clinical Software + Email Software (Outlook) and Teams + MS Word + Managed Care **EDUCATION** **Required** + Doctor of Medicine or Doctor of Osteopathic Medicine **Substitutions** + None **Preferred** + None **LICENSES or CERTIFICATIONS** **Required** + Medical Doctor OR Doctor of Osteopathic Medicine (DO), Board certified in an American Board of Medical Specialties or Bureau of Osteopathic, Specialists recognized specialty credentialed in a Highmark network + Active medical state licensure required. Additional specific state licensure(s) may be required based on business need. **Preferred** + None **Language (Other than English):** + None **Travel Required:** + Less than 25% **PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS** **Position Type** + Office-Based or Remote Position **Physical work site required** + Never **_Disclaimer:_** _The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job._ **_Compliance Requirement_** _: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies._ _As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company's Handbook of Privacy Policies and Practices and Information Security Policy._ _Furthermore, it is every employee's responsibility to comply with the company's Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements._ **Pay Range Minimum:** $170,000.00 **Pay Range Maximum:** $352,500.00 _Base pay is determined by a variety of factors including a candidate's qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets._ Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law. We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below. For accommodation requests, please contact HR Services Online at ***************************** California Consumer Privacy Act Employees, Contractors, and Applicants Notice Req ID: J273814

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

Job Title: Chief Medical Officer (CMO) Reports to: Chief Executive Officer Department: Medical FLSA Status: Exempt Job Grade: P General Responsibilities: The Chief Medical Officer is the senior clinical leader at Thundermist Health Center, responsible for overseeing and guiding the delivery of high-quality medical, dental, behavioral health and pharmacy services across all Thundermist Health Center sites and programs. As a member of the executive team, the CMO plays a critical role in strategic planning, clinical quality improvement, provider retention, recruitment and performance, risk management and population health. The CMO interacts regularly with the Board of Directors and serves as a liaison between the health center and the wider health professional community. Qualifications: Required Qualifications: Licensed MD, DO or NP in good standing in Rhode Island If MD or DO, Board-certified in Internal Medicine, Pediatrics, Family Medicine, or Obstetrics/Gynecology At least five years of clinical leadership experience Preferred Qualifications: Community Health Center experience Master of Public Health (MPH), Healthcare Administration or Business Administration Skills, experience or credentials/certifications that demonstrate executive and strategic leadership capabilities Significant Job Functions: Clinical Leadership and Strategy Provide visible, day-to-day leadership for providers and teams, fostering a culture of teamwork, accountability, collaboration and excellence. Serve as the lead architect of evidence-based clinical protocols, population health and health equity initiatives to address the health needs of the communities served. Build and support an effective structure for site and department-based clinical leadership. Collaborate with executive leadership to align clinical priorities with organizational goals and strategic plans. Represent THC in external partnerships, networks and community-facing initiatives. Quality Improvement (QI) and Compliance Supervise clinical quality improvement efforts and serve as liaison to the board of directors' Quality Improvement committee. Establish and achieve clinical QI goals for the organization, considering priorities from HRSA, Thundermist's value-based care relationships, and population health needs and priorities. Through close partnership and indirect clinical oversight of Thundermist compliance and clinical risk management teams, ensure compliance with HRSA, NCQA-PCMH, ACGME, AACN and other state and federal regulatory and accrediting bodies. Ensure provider engagement in development of strategies to measure and improve patient experience, including timely investigation and response to patient complaints. Ensure continuous maintenance of FTCA deeming through submission of annual quality plan, and maintenance of processes to support the plan including provider peer review and clinical risk management process and documentation. Operations and Staffing Participate in organizational planning and budgeting efforts. Oversee strategies for recruitment, credentialing, privileging, onboarding and retention of providers, including any performance incentive or bonus plans. Participate in final determination of disciplinary actions and terminations of medical personnel with the Chief Human Resources Officer. Ensure timely and effective performance feedback and evaluation process for providers to ensure all providers meet or exceed clinical and productivity benchmarks. Direct Patient Care & Clinical Practice Provide at least one day per week of direct patient care. Maintain timely, complete, and compliant medical documentation in accordance with organizational standards Provide call coverage as required. Participate in periodic clinical reviews, including federal program reviews; with the assistance of compliance staff, monitor compliance with such standards. Physical Effort/ Environment: This is a hybrid position, allowing some portion of duties to be performed remotely. While certain accommodations can be made, position requires some physical exertion and dexterity in performing certain medical procedures and rendering patient care. Transportation is needed to hospital and other patient care settings. Work Schedule Demands: Full time (40 hours, plus), to include weekly clinical hours and administrative hours Communication Skills: Exceptional oral and written skills needed. Confidentiality of Information: The Chief Medical Officer shall maintain the confidentiality of all agency information, including business records, personnel matters, and any Protected Health Information (PHI), in strict compliance with applicable federal and state laws, including HIPAA. Unauthorized disclosure of confidential information is strictly prohibited and may result in disciplinary action up to and including termination. ADA & EEOC Statement: Thundermist is dedicated to building and maintaining a diverse and inclusive workforce committed to caring for patients in a manner that is respectful of cultural differences. We are an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, gender identity, national origin, disability status, protected veteran status, or any other characteristic protected by law. Should you be interested in this position please reach out to our partners: Lauren Glaccum Email: **************************** Tricia Lafond Email: ***************************

We're not just a workplace - we're a Great Place to Work certified employer! Proudly certified as a Great Place to Work, we are dedicated to creating a supportive and inclusive environment. At Sonic Healthcare USA, we emphasize teamwork and innovation. Check out our job openings and advance your career with a company that values its team members! University Pathologists (UPLLC), a Sonic Healthcare USA Partner, invites applications for a dynamic and engaging Surgical Pathologist to join our esteemed team as the Medical Director for a two-hospital system in vibrant Providence, Rhode Island. This is an exceptional opportunity for a motivated and experienced pathologist with expertise in Hematopathology and clinical laboratory operations to take on a leadership role within a well-established and growing multi-specialty practice. As Medical Director, you will play a pivotal role in shaping the delivery of high-quality pathology services across two hospital sites, working collaboratively with clinicians, administrators, and laboratory staff. Your surgical pathology skills, coupled with your Hematopathology and clinical laboratory acumen, will be essential in serving a diverse range of inpatient and outpatient clients. Why Choose University Pathologists and Rhode Island? Nestled in the heart of the Northeast corridor, Providence offers the perfect blend of urban convenience and charming New England living. Enjoy easy access to the cultural and economic hubs of Boston and New York City via convenient train or car routes, all while benefiting from a more relaxed pace of life and a lower cost of living. Rhode Island is also home to elite academic institutions like Brown University, fostering a collaborative and forward-thinking environment that encourages professional growth and impactful contributions. This is an ideal location for those seeking to make a real difference in a supportive and intellectually stimulating setting. Your Responsibilities Will Include: * Serving as the Medical Director for pathology services across a two-hospital system. * Providing expert diagnostic services in surgical pathology. * Utilizing your Hematopathology expertise in the diagnosis and management of hematologic disorders. * Contributing to the effective and efficient operation of the clinical laboratory. * Collaborating effectively with clinicians, administrators, and laboratory staff to ensure seamless patient care. * Working independently while contributing to the overall success of University Pathologists. We Are Seeking Candidates Who Possess: * Board certification in AP/CP (Anatomic and Clinical Pathology). * Fellowship training or significant experience in Hematopathology. * A commitment to providing outstanding, client-centric pathology services. * The ability to thrive in a collaborative environment and work effectively both independently and as part of a team. Why University Pathologists is the Right Choice for You: University Pathologists (UPLLC) is a growing, multi-specialty, multi-state professional group comprised of 18 experienced pathologists. As a Sonic Healthcare USA partner, we are dedicated to providing comprehensive Anatomic and Clinical Pathology services to numerous hospitals, surgery centers, and outpatient facilities throughout Southern New England. Our client-centric approach underscores our belief that healthcare is personal and best delivered locally. We pride ourselves on our extensive pathology expertise, which allows us to support comprehensive and integrated approaches to patient care, bringing personalized pathology services closer to those we serve. Benefits: * Competitive salary commensurate with background and experience * 6 weeks of paid time off (4 weeks PTO, 2 weeks CME/conference time) * 5 days of sick leave * CME allowance of $5,000 per year * Relocation assistance * Sign-on bonus * Comprehensive benefits package, including medical, dental, and a matched 401K plan Salary minimum to max is $300K to $400K. Pay is commensurate with experience and subspecialty training; geographic differentials to the pay range may apply. Sonic Healthcare USA, reserves the right to pay more or less than the posted range. Any difference between actual compensation and the posted range will be based on factors other than race, color, religion, sex (including pregnancy) or national origin. Scheduled Weekly Hours: 40 Work Shift: Job Category: Pathology Company: University Pathologists LLC Sonic Healthcare USA is an equal opportunity employer that celebrates diversity and is committed to an inclusive workplace for all employees. We prohibit discrimination and harassment of any kind based on race, color, sex, religion, age, national origin, disability, genetics, veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.

**Become a part of our caring community and help us put health first** Become a part of our caring community and help us put health first The Medical Director actively uses their medical background, experience, and judgement to make determinations whether requested services, level of care, and/or site of service should be authorized. All work occurs within a context of regulatory compliance, and work is assisted by diverse resources, which may include national clinical guidelines, CMS policies and determinations, clinical reference materials, internal teaching conferences, and other reference sources. Medical Directors will learn Medicare and Medicare Advantage requirements and will understand how to operationalize this knowledge in their daily work. Willingness to work every other weekend with compensated days off during the work week The Medical Director's work includes reviewing of all submitted medical records, synthesizing complex hospital-based clinical scenarios, and providing expert decisioning on the requested services. They will have regular discussions with external providers by phone to gather additional clinical information and discuss determinations. Medical directors are expected to understand Humana processes with a focus on collaborative professional relationships. The ideal candidate will have a high degree of integrity, professionalism, resourcefulness, and enjoy working in a team-based environment. Medical Directors support Humana value throughout all activities. **Responsibilities** The Medical Director provides medical interpretation and determinations whether services provided by other healthcare professionals are concordant with national guidelines, CMS requirements, Humana policies, clinical standards, and (in some cases) contracts. After completion of structured and mentored training, daily work is performed with minimal direction, but with ready support from other team members. The ideal candidate enjoys working in a structured environment with expectations for consistency in thinking and authorship. Exercises independence in meeting departmental expectations and meets compliance timelines. + Conduct comprehensive, timely, and compliant medical necessity reviews for inpatient services + Maintain accountability for productivity, quality, and compliance metrics + Communicate determinations clearly both verbally and in writing + Demonstrate adaptability and willingness to learn evolving workflows, tools, and utilization management practices + **Willingness to work every other weekend with compensated days off during the work week** **Use your skills to make an impact** **Use your skills to make an impact** **Required Qualifications** + MD or DO degree + 5+ years of direct clinical patient care experience post residency or fellowship, which preferably includes some experience in an inpatient environment and/or related to care of a Medicare type population (disabled or >65 years of age). + Current and ongoing Board Certification an approved ABMS Medical Specialty + A current and unrestricted license in at least one jurisdiction and willing to obtain additional license, if required. + No current sanction from Federal or State Governmental organizations, and able to pass credentialing requirements. + Excellent verbal and written communication skills. + Evidence of analytic and interpretation skills, with prior experience working in a team environment **Preferred Qualifications** + Knowledge of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical management organizations, hospitals/ Integrated Delivery Systems, health insurance, or other healthcare providers. + Utilization management experience in a medical management review organization, such as Medicare Advantage, Managed Medicaid, or Commercial health insurance. + Experience with national guidelines such as MCG or InterQual + Experience in hospital-based clinical practice, including specialties of Internal Medicine, Family Practice, Geriatrics, Hospitalist, Emergency Medicine, and hospital-based clinical specialists + The curiosity to learn and the flexibility to adapt to changes in order to enhance efficiency, productivity, and organizational goals. + Ability to thrive in a dynamic fast-paced, team-oriented environment. + Commitment to a culture of innovation, including being facile with using technology to improve workflows + Participate in educational activities by attending required conferences and also create content to lead/teach/present for individual subject matter contribution + Passionate about contributing to an organization's focus on consistency in outcomes, consumer experiences and a highly engaged team culture **Additional Information** The medical director reports to a Lead Medical Director. Participation in weekend work on a rotational basis to ensure cases are decisioned in a timely manner May participate on project teams or organizational committees. \#physiciancareers Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. **Scheduled Weekly Hours** 40 **Pay Range** The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $223,800 - $313,100 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. **Description of Benefits** Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. Application Deadline: 02-28-2026 **About us** Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. **Equal Opportunity Employer** It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our ***************************************************************************

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

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

**Your Future Evolves Here** Evolent partners with health plans and providers to achieve better outcomes for people with most complex and costly health conditions. Working across specialties and primary care, we seek to connect the pieces of fragmented health care system and ensure people get the same level of care and compassion we would want for our loved ones. Evolent employees enjoy work/life balance, the flexibility to suit their work to their lives, and autonomy they need to get things done. We believe that people do their best work when they're supported to live their best lives, and when they feel welcome to bring their whole selves to work. That's one reason why diversity and inclusion are core to our business. Join Evolent for the mission. Stay for the culture. **What You'll Be Doing:** As a Vascular Surgery, Field Medical Director you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in patients' lives, in a non-clinical environment. You can enjoy better work- life balance on a team that values collaboration and continuous learning while providing better health outcomes. **Collaboration Opportunities:** + Routinely interacts with leadership and management staff, other Physicians, and staff whenever a physician`s input is needed or required. **What You Will Be Doing:** + Serve as the specialty match reviewer in Vascular cases, that do not initially meet the applicable medical necessity guidelines, as well as other imaging requests when providers, clients, or state laws require specialty reviews to be completed by the subject matter expert. + Discusses determinations (peer to peer phone calls) with requesting physicians or ordering providers, when available, within the regulatory timeframe of the request. + Provides clinical rationale for standard and expedited appeals. + Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD review process to reflect appropriate utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance (NCQA) guidelines. + Aids and acts as a resource to Initial Clinical Reviewers. + Ensures documentation of all communications with medical office staff and/or MD provider is recorded in a timely and accurate manner. + Participates in on-going training per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. + On a requested basis, may function as Medical Director for selecting health plans or regions, assuming overall accountability for utilization management while working in conjunction with the Senior Medical Director. **Qualifications - Required and Preferred:** + MD/DO/MBBS- Required + Minimum of five (5) years' experience in the practice of Vascular Surgeon- Preferred + Current, unrestricted clinical license in medicine or required specialty- Required + Obtaining and maintaining medical licenses in the state you reside- Required + Active Board Certification in Vascular Surgery or Active Board Certification in General Surgery with extensive experience in Vascular Surgery- Required + Strong clinical, management, communication, and organizational skills-Required + Energetic and curious with a passion for quality and value in health care-Required + Computer Proficiency-Required To ensure a secure hiring process we have implemented several identity verification steps, including submission of a government issued photo ID. We conduct identity verification during interviews, and final interviews may require onsite attendance. All candidates must complete a comprehensive background check, in-person I-9 verification, and may be subject to drug screening prior to employment. The use of artificial intelligence tools during interviews is prohibited and monitored. Misrepresentation will result in immediate disqualification from consideration. **Technical Requirements:** We require that all employees have the following technical capability at their home: High speed internet over 10 Mbps and, specifically for all call center employees, the ability to plug in directly to the home internet router. These at-home technical requirements are subject to change with any scheduled re-opening of our office locations. **Evolent is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, or disability status.** **If you need reasonable accommodation to access the information provided on this website, please contact** ************************** **for further assistance.** The expected base salary/wage range for this position is $130-$140/hr. This position is also eligible for a bonus component that would be dependent on pre-defined performance factors. As part of our total compensation package, Evolent is proud to offer comprehensive benefits (including health insurance benefits) to qualifying employees. All compensation determinations are based on the skills and experience required for the position and commensurate with experience of selected individuals, which may vary above and below the stated amounts. Don't see the dream job you are looking for? Drop off your contact information and resume and we will reach out to you if we find the perfect fit!

**Your Future Evolves Here** Evolent partners with health plans and providers to achieve better outcomes for people with most complex and costly health conditions. Working across specialties and primary care, we seek to connect the pieces of fragmented health care system and ensure people get the same level of care and compassion we would want for our loved ones. Evolent employees enjoy work/life balance, the flexibility to suit their work to their lives, and autonomy they need to get things done. We believe that people do their best work when they're supported to live their best lives, and when they feel welcome to bring their whole selves to work. That's one reason why diversity and inclusion are core to our business. Join Evolent for the mission. Stay for the culture. **What You'll Be Doing:** As a Cardiology, Field Medical Director you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in patients lives, in a non-clinical environment. You can enjoy better work- life balance on a team that values collaboration and continuous learning while providing better health outcomes. **Collaboration Opportunities:** + Routinely interacts with leadership and management staff, other Physicians, and staff whenever a physician`s input is needed or required. As well as, aids and acts as a resource to Initial Clinical Reviewers. **What You Will Be Doing:** + Serve as the specialty match reviewer in Cardiology cases, that do not initially meet the applicable medical necessity guidelines, as well as other requests when providers, clients, or state laws require specialty reviews to be completed by the subject matter expert. + Provides clinical rationale for standard and expedited appeals. + Discusses determinations (peer to peer phone calls) with requesting physicians or ordering providers, when available, within the regulatory timeframe of the request. + Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD review process to reflect appropriate utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance (NCQA) guidelines. + Ensures documentation of all communications with medical office staff and/or MD provider is recorded in a timely and accurate manner. + Participates in on-going training per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. + On a requested basis, may function as Medical Director for selecting health plans or regions, assuming overall accountability for utilization management while working in conjunction with the Senior Medical Director. **Qualifications - Required and Preferred:** + MD/DO/MBBS Degree + Current, unrestricted clinical license in medicine or required specialty + Obtaining and maintaining medical licenses in the state you reside, as well as, other state licensure required per business needs + Active Board Certification in Cardiology, Vascular Surgery or Adult Congenital Heart Disease + Strong clinical, management, communication, and organizational skills + Energetic and curious with a passion for quality and value in health care + Computer Proficiency + Minimum of five (5) years' experience in the practice of Cardiology is preferred + Not under current exclusion or sanction by any state or federal health care program, including Medicare or Medicaid, and is not identified as an "excluded person" by the Office of Inspector General of the Department of Health and Human Services or the General Service Administration (GSA), or reprimanded or sanctioned by Medicare. + No history of a major disciplinary or legal action by a state medical board To ensure a secure hiring process we have implemented several identity verification steps, including submission of a government issued photo ID. We conduct identity verification during interviews, and final interviews may require onsite attendance. All candidates must complete a comprehensive background check, in-person I-9 verification, and may be subject to drug screening prior to employment. The use of artificial intelligence tools during interviews is prohibited and monitored. Misrepresentation will result in immediate disqualification from consideration. **Technical Requirements:** We require that all employees have the following technical capability at their home: High speed internet over 10 Mbps and, specifically for all call center employees, the ability to plug in directly to the home internet router. These at-home technical requirements are subject to change with any scheduled re-opening of our office locations. **Evolent is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, or disability status.** **If you need reasonable accommodation to access the information provided on this website, please contact** ************************** **for further assistance.** The expected base salary/wage range for this position is $120-$135/hr. This position is also eligible for a bonus component that would be dependent on pre-defined performance factors. As part of our total compensation package, Evolent is proud to offer comprehensive benefits (including health insurance benefits) to qualifying employees. All compensation determinations are based on the skills and experience required for the position and commensurate with experience of selected individuals, which may vary above and below the stated amounts. Don't see the dream job you are looking for? Drop off your contact information and resume and we will reach out to you if we find the perfect fit!

**Your Future Evolves Here** Evolent partners with health plans and providers to achieve better outcomes for people with most complex and costly health conditions. Working across specialties and primary care, we seek to connect the pieces of fragmented health care system and ensure people get the same level of care and compassion we would want for our loved ones. Evolent employees enjoy work/life balance, the flexibility to suit their work to their lives, and autonomy they need to get things done. We believe that people do their best work when they're supported to live their best lives, and when they feel welcome to bring their whole selves to work. That's one reason why diversity and inclusion are core to our business. Join Evolent for the mission. Stay for the culture. **What You'll Be Doing:** **Lead the Transformation in Oncology Care** At Evolent, we're redefining how care is delivered for individuals facing cancer. As a Performance Suite Medical Director in Medical Oncology, you will play a pivotal role in advancing value-based care models that prioritize clinical excellence, patient-centered outcomes, and system-wide impact. This role offers the opportunity to collaborate with top-tier clinicians, influence care pathways, and drive innovation in one of the most critical areas of health care. If you're passionate about making a measurable difference in oncology, this is your platform to lead with purpose. In this role, you will combine your clinical oncology expertise with a focus on **value-based strategy and transformation** . Unlike traditional medical review roles that emphasize volume throughput, this position integrates utilization management with collaborative engagement and innovation. **Core Responsibilities** + **Clinical Review & Peer Collaboration** + Serve as the physician reviewer for oncology cases that do not initially meet medical necessity criteria, applying evidence-based guidelines to ensure high-quality and cost-effective care. + Conduct peer-to-peer discussions with requesting oncologists-not only to explain determinations but to **partner in driving practice patterns aligned with value and quality outcomes** . + Support clinical reviewers as a subject matter expert and resource. + **Practice & Physician Engagement** + Actively participate in **engagement sessions with oncology practices** , sharing best clinical practices and supporting broader adoption of evidence-based pathways. + Foster trusted peer relationships with oncologists to encourage **sustainable behavior change** that improves patient outcomes. + Support practice-level transformation initiatives that reduce unwarranted variation and enhance quality. + **Internal Strategy & Value Initiatives** + Collaborate with Evolent's clinical leadership on the **design, build, and execution of new value initiatives in oncology** . + Provide input on innovation opportunities, clinical algorithms, and models of care that support transformation in specialty care. + Partner with operational and analytic teams to assess the impact of interventions and identify opportunities for continuous improvement. + Participate in audit processes to validate accuracy of advance payment model payouts, ensuring alignment with clinical documentation, performance metrics, and contractual expectations. + **Compliance & Quality** + Ensure all reviews and engagements align with URAC, NCQA, and internal quality standards. + Document peer interactions and clinical decisions in a timely and accurate manner. + Participate in training and inter-rater reliability processes. **Qualifications** + MD/DO/MBBS with board certification in **Medical Oncology** . + Minimum five (5) years' post-residency experience, with active clinical practice preferred within the past 2 years. + Current, unrestricted medical license (multiple state licenses preferred or willingness to obtain). + Demonstrated **leadership in practice transformation, value-based care, or clinical quality improvement** . + Strong communication, collaboration, and organizational skills, with proven ability to influence physician behavior. + Energetic, curious, and passionate about **shaping the future of oncology care delivery** . + Not under sanction or exclusion from Medicare/Medicaid programs. To ensure a secure hiring process we have implemented several identity verification steps, including submission of a government issued photo ID. We conduct identity verification during interviews, and final interviews may require onsite attendance. All candidates must complete a comprehensive background check, in-person I-9 verification, and may be subject to drug screening prior to employment. The use of artificial intelligence tools during interviews is prohibited and monitored. Misrepresentation will result in immediate disqualification from consideration. **Technical Requirements:** We require that all employees have the following technical capability at their home: High speed internet over 10 Mbps and, specifically for all call center employees, the ability to plug in directly to the home internet router. These at-home technical requirements are subject to change with any scheduled re-opening of our office locations. **Evolent is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, or disability status.** **If you need reasonable accommodation to access the information provided on this website, please contact** ************************** **for further assistance.** The expected base salary/wage range for this position is $120-130/hr. This position is also eligible for a bonus component that would be dependent on pre-defined performance factors. As part of our total compensation package, Evolent is proud to offer comprehensive benefits (including health insurance benefits) to qualifying employees. All compensation determinations are based on the skills and experience required for the position and commensurate with experience of selected individuals, which may vary above and below the stated amounts. Don't see the dream job you are looking for? Drop off your contact information and resume and we will reach out to you if we find the perfect fit!

**Your Future Evolves Here** Evolent partners with health plans and providers to achieve better outcomes for people with most complex and costly health conditions. Working across specialties and primary care, we seek to connect the pieces of fragmented health care system and ensure people get the same level of care and compassion we would want for our loved ones. Evolent employees enjoy work/life balance, the flexibility to suit their work to their lives, and autonomy they need to get things done. We believe that people do their best work when they're supported to live their best lives, and when they feel welcome to bring their whole selves to work. That's one reason why diversity and inclusion are core to our business. Join Evolent for the mission. Stay for the culture. **What You'll Be Doing:** As a Physician Clinical Reviewer, Interventional Pain Management, you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in patients' lives, in a non-clinical environment. You can enjoy better work- life balance on a team that values collaboration and continuous learning while providing better health outcomes. **Collaboration Opportunities:** + Routinely interacts with leadership and management staff, other Physicians, and staff whenever a physician`s input is needed or required. Aids and acts as a resource to Initial Clinical Reviewers. **What You Will Be Doing:** + Serve as the Physician Clinical Reviewer for Interventional Pain Management, reviewing cases that do not initially meet the applicable medical necessity guidelines, as well as other imaging requests when providers, clients, or state laws require specialty reviews to be completed by the subject matter expert. + Discusses determinations (peer to peer phone calls) with requesting physicians or ordering providers, when available, within the regulatory timeframe of the request. + Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD review process to reflect appropriate utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance (NCQA) guidelines. + Provides clinical rationale for standard and expedited appeals. + Ensures documentation of all communications with medical office staff and/or MD provider is recorded in a timely and accurate manner. + Participates in on-going training per inter-rater reliability process. + On a requested basis, may function as Medical Director for selecting health plans or regions, assuming overall accountability for utilization management while working in conjunction with the Senior Medical Director. May assist the Senior Medical Director in research activities/questions. **Qualifications - Required and Preferred:** + MD/DO/MBBS- **Required** + Minimum of five (5) years' experience in the practice of Pain Medicine, post-residency- **Preferred** + Current, unrestricted clinical license in medicine or required specialty- **Required** + Obtaining and maintaining medical licenses in the state you reside and any required per business needs- **Required** + Active Board Certification in Pain Management or Active Board Certification in another specialty and clinical experience in Interventional Pain Management- **Required** + Strong clinical, management, communication, and organizational skills- **Required** + Energetic and curious with a passion for quality and value in health care- **Required** + Computer Proficiency- **Required** To ensure a secure hiring process we have implemented several identity verification steps, including submission of a government issued photo ID. We conduct identity verification during interviews, and final interviews may require onsite attendance. All candidates must complete a comprehensive background check, in-person I-9 verification, and may be subject to drug screening prior to employment. The use of artificial intelligence tools during interviews is prohibited and monitored. Misrepresentation will result in immediate disqualification from consideration. **Technical Requirements:** We require that all employees have the following technical capability at their home: High speed internet over 10 Mbps and, specifically for all call center employees, the ability to plug in directly to the home internet router. These at-home technical requirements are subject to change with any scheduled re-opening of our office locations. **Evolent is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, or disability status.** **If you need reasonable accommodation to access the information provided on this website, please contact** ************************** **for further assistance.** The expected base salary/wage range for this position is $105-110/hr. This position is also eligible for a bonus component that would be dependent on pre-defined performance factors. As part of our total compensation package, Evolent is proud to offer comprehensive benefits (including health insurance benefits) to qualifying employees. All compensation determinations are based on the skills and experience required for the position and commensurate with experience of selected individuals, which may vary above and below the stated amounts. Don't see the dream job you are looking for? Drop off your contact information and resume and we will reach out to you if we find the perfect fit!

**Your Future Evolves Here** Evolent partners with health plans and providers to achieve better outcomes for people with most complex and costly health conditions. Working across specialties and primary care, we seek to connect the pieces of fragmented health care system and ensure people get the same level of care and compassion we would want for our loved ones. Evolent employees enjoy work/life balance, the flexibility to suit their work to their lives, and autonomy they need to get things done. We believe that people do their best work when they're supported to live their best lives, and when they feel welcome to bring their whole selves to work. That's one reason why diversity and inclusion are core to our business. Join Evolent for the mission. Stay for the culture. **What You'll Be Doing:** As a Physician Clinical Reviewer, Interventional Pain Management, you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in patients' lives, in a non-clinical environment. You can enjoy better work- life balance on a team that values collaboration and continuous learning while providing better health outcomes. **Collaboration Opportunities:** + Routinely interacts with leadership and management staff, other Physicians, and staff whenever a physician`s input is needed or required. Aids and acts as a resource to Initial Clinical Reviewers. **What You Will Be Doing:** + Serve as the Physician Clinical Reviewer for Interventional Pain Management, reviewing cases that do not initially meet the applicable medical necessity guidelines, as well as other imaging requests when providers, clients, or state laws require specialty reviews to be completed by the subject matter expert. + Discusses determinations (peer to peer phone calls) with requesting physicians or ordering providers, when available, within the regulatory timeframe of the request. + Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD review process to reflect appropriate utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance (NCQA) guidelines. + Provides clinical rationale for standard and expedited appeals. + Ensures documentation of all communications with medical office staff and/or MD provider is recorded in a timely and accurate manner. + Participates in on-going training per inter-rater reliability process. + On a requested basis, may function as Medical Director for selecting health plans or regions, assuming overall accountability for utilization management while working in conjunction with the Senior Medical Director. May assist the Senior Medical Director in research activities/questions. **Qualifications - Required and Preferred:** + MD/DO/MBBS- **Required** + Minimum of five (5) years' experience in the practice of Pain Medicine, post-residency- **Preferred** + Current, unrestricted clinical license in medicine or required specialty- **Required** + Obtaining and maintaining medical licenses in the state you reside and any required per business needs- **Required** + Active Board Certification in Pain Management or another Active Board Certification and clinical experience in Interventional Pain Management- **Required** + Strong clinical, management, communication, and organizational skills- **Required** + Energetic and curious with a passion for quality and value in health care- **Required** + Computer Proficiency- **Required** To ensure a secure hiring process we have implemented several identity verification steps, including submission of a government issued photo ID. We conduct identity verification during interviews, and final interviews may require onsite attendance. All candidates must complete a comprehensive background check, in-person I-9 verification, and may be subject to drug screening prior to employment. The use of artificial intelligence tools during interviews is prohibited and monitored. Misrepresentation will result in immediate disqualification from consideration. **Technical Requirements:** We require that all employees have the following technical capability at their home: High speed internet over 10 Mbps and, specifically for all call center employees, the ability to plug in directly to the home internet router. These at-home technical requirements are subject to change with any scheduled re-opening of our office locations. **Evolent is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, or disability status.** **If you need reasonable accommodation to access the information provided on this website, please contact** ************************** **for further assistance.** The expected base salary/wage range for this position is $100-$110/hr. This position is also eligible for a bonus component that would be dependent on pre-defined performance factors. As part of our total compensation package, Evolent is proud to offer comprehensive benefits (including health insurance benefits) to qualifying employees. All compensation determinations are based on the skills and experience required for the position and commensurate with experience of selected individuals, which may vary above and below the stated amounts. Don't see the dream job you are looking for? Drop off your contact information and resume and we will reach out to you if we find the perfect fit!

TeamHealth has an outstanding opportunity for an experienced emergency medicine (EM) physician to step into a medical director role at Our Lady of Fatima Hospital in North Providence, Rhode Island. This is your chance to lead a dedicated emergency department team in a close-knit community hospital that combines clinical excellence with small-town warmth - all just minutes from the Rhode Island coast. As medical director, you'll oversee a 29-bed emergency department with an annual patient volume of 25,000. You'll guide a strong clinical team with 24 hours of physician coverage and 12 hours of APC coverage daily, while driving initiatives in quality, patient safety, and operational performance. This leadership role offers you the chance to shape ED strategy, mentor colleagues, and directly influence patient care outcomes in a respected, mission-driven facility. This is an independent contractor position with the ability to earn highly competitive compensation. Candidates must be board certified in emergency medicine with proven leadership experience or strong leadership potential. If you're ready to elevate your career as an EM leader while enjoying the lifestyle and beauty of coastal New England, we invite you to apply today! California Applicant Privacy Act: *************************************************************** City Caption North Providence, Rhode Island City Description Centrally located in the northwestern corner of the Providence metropolitan area, North Providence offers its residents and surrounding communities, many attractions of living close to a large city, yet maintains a small town atmosphere with suburban flair. North Providence offers numerous services, outstanding parks, recreational facilities and commodities to suit everyone's needs. Facility Caption Our Lady of Fatima Hospital Facility Description Fatima Hospital was established on 1950 by the Catholic Diocese of Providence. Our Lady of Fatima Hospital receives an annual volume of 30,000 and has a 23-bed emergency department (ED). In recent years Fatima has earned dozens of national accreditations and recognitions for quality performance. These have been given by tough, independent, and objective arbiters of hospital care, such as the Joint Commission, the American College of Surgery and Blue Cross Blue Shield. Job Benefits - Lead a high-performing ED with the support of a respected national physician practice - Competitive compensation and director stipend - Professional liability insurance with tail coverage - Leadership development, CME, and professional growth through TeamHealth Institute - Local and national leadership development support - Clinician wellness resources and work-life balance initiatives - Recognition and career advancement within a stable, forward-thinking organization

TeamHealth is seeking an experienced and innovative EMS medical director to join our emergency department (ED) team at Roger Williams Medical Center in Providence, Rhode Island. You also serve Our Lady of Fatima in North Providence. You have the potential to earn terrific compensation at a close-knit community hospital just minutes from the beach. Join us in the ocean state in an ED that is driven by teamwork and a commitment to quality. This North Providence ED sees an annual patient volume of 29,000, and we provide 24 hours of physician coverage and 16 hours of advanced practice clinician coverage daily. This is an independent contractor position. We ask that you be ABEM/AOBEM board certified or board eligible. Opportunity Overview Access to professional development tools, educational resources and CME through TeamHealth Institute Association with a leading physician practice in the U.S. Stability of a respected industry leader Leadership and growth opportunities to further your career Access to TeamHealth's clinician wellness program Forward thinking leadership To learn more, apply today. California Applicant Privacy Act: *************************************************************** City Caption North Providence, Rhode Island City Description Centrally located in the northwestern corner of the Providence metropolitan area, North Providence offers its residents and surrounding communities, many attractions of living close to a large city, yet maintains a small town atmosphere with suburban flair. North Providence offers numerous services, outstanding parks, recreational facilities and commodities to suit everyone's needs. Facility Caption Fatima Hospital Facility Description Fatima Hospital was established on 1950 by the Catholic Diocese of Providence. Our Lady of Fatima Hospital receives an annual volume of 30,000 and has a 23-bed emergency department (ED). In recent years Fatima has earned dozens of national accreditations and recognitions for quality performance. These have been given by tough, independent, and objective arbiters of hospital care, such as the Joint Commission, the American College of Surgery and Blue Cross Blue Shield. Job Benefits - Generous EMS director stipend - Robust leadership development resources from TeamHealth Institute - TeamHealth promotes from within so there are many opportunities grow into local, regional and national leadership roles - Extremely competitive compensation - Generous sign-on and relocation incentives for the right candidate - Other benefits include mentorship and support of a national network of world-class emergency medicine experts

**Your Future Evolves Here** Evolent partners with health plans and providers to achieve better outcomes for people with most complex and costly health conditions. Working across specialties and primary care, we seek to connect the pieces of fragmented health care system and ensure people get the same level of care and compassion we would want for our loved ones. Evolent employees enjoy work/life balance, the flexibility to suit their work to their lives, and autonomy they need to get things done. We believe that people do their best work when they're supported to live their best lives, and when they feel welcome to bring their whole selves to work. That's one reason why diversity and inclusion are core to our business. Join Evolent for the mission. Stay for the culture. **What You'll Be Doing:** As a FMD, Radiology you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in patients lives, in a non-clinical environment. You can enjoy better work- life balance on a team that values collaboration and continuous learning while providing better health outcomes. **Collaboration Opportunities:** + Routinely interacts with leadership and management staff, other Physicians, and staff whenever a physician`s input is needed or required. **What You Will Be Doing:** + Serve as the Physician match reviewer in Imaging cases, that do not initially meet the applicable medical necessity guidelines, as well as other imaging requests when providers, clients, or state laws require specialty reviews to be completed by the subject matter expert. + Discusses determinations (peer to peer phone calls) with requesting physicians or ordering providers, when available, within the regulatory timeframe of the request and provides clinical rationale for standard and expedited appeals. + Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD review process to reflect appropriate utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance (NCQA) guidelines. + Aids and acts as a resource to Initial Clinical Reviewers. + Ensures documentation of all communications with medical office staff and/or MD provider is recorded in a timely and accurate manner. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. + Participates in on-going training per inter-rater reliability process. **Qualifications:** + MD/DO/MBBS + Minimum of five (5) years' experience in the practice of Medicine, post residency and Active Clinical practice within the last 2 years is preferred + Current, unrestricted clinical license in medicine or required specialty- + Obtaining and maintaining medical licenses in the state you reside, as well as, any license required per business needs + Active Board Certification by an accredited organization + Strong clinical, management, communication, and organizational skills + Energetic and curious with a passion for quality and value in health care + Computer Proficiency + Not under current exclusion or sanction by any state or federal health care program, including Medicare or Medicaid, and is not identified as an "excluded person" by the Office of Inspector General of the Department of Health and Human Services or the General Service Administration (GSA), or reprimanded or sanctioned by Medicare. + No history of a major disciplinary or legal action by a state medical board To ensure a secure hiring process we have implemented several identity verification steps, including submission of a government issued photo ID. We conduct identity verification during interviews, and final interviews may require onsite attendance. All candidates must complete a comprehensive background check, in-person I-9 verification, and may be subject to drug screening prior to employment. The use of artificial intelligence tools during interviews is prohibited and monitored. Misrepresentation will result in immediate disqualification from consideration. **Technical Requirements:** We require that all employees have the following technical capability at their home: High speed internet over 10 Mbps and, specifically for all call center employees, the ability to plug in directly to the home internet router. These at-home technical requirements are subject to change with any scheduled re-opening of our office locations. **Evolent is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, or disability status.** **If you need reasonable accommodation to access the information provided on this website, please contact** ************************** **for further assistance.** The expected base salary/wage range for this position is $94-99/hr. This position is also eligible for a bonus component that would be dependent on pre-defined performance factors. As part of our total compensation package, Evolent is proud to offer comprehensive benefits (including health insurance benefits) to qualifying employees. All compensation determinations are based on the skills and experience required for the position and commensurate with experience of selected individuals, which may vary above and below the stated amounts. Don't see the dream job you are looking for? Drop off your contact information and resume and we will reach out to you if we find the perfect fit!

Job Summary: Under the supervision of the CEO of PACE the Chief Medical Officer provides general medical direction and supervision of the medical aspects of care for PACE-RI. In conjunction with the Chief of Clinical Services provides direction and supervision of related primary care, nursing, and allied health services. The Chief Medical Officer has authority over the quality improvement program within PACE and sets forth a philosophy of care through the development of protocols, education, and best practices. Job Duties/Responsibilities: Assumes overall accountability and responsibility for the medical care of the participants of PACE-RI. Provides direct primary care for an appropriate panel size of participants. Performs comprehensive history and physical on new enrollees within 30 days of enrollment Performs interval assessments on established participants, semi-annually or as directed. Evaluates and treats participants with episodic illnesses and informs IDT as to the chronic and acute care trajectory. Judiciously utilizes and oversees the use of specialist consultations as needed Admits participants to hospital, providing primary care attending responsibilities; and/or coordinates and manages care through pro-active collaboration with hospitalist, provides updates to the IDT on a regular basis, and assists with actively coordinating discharge planning with IDT Manages all care of participants in the nursing home, conducts regular visits, and performs telephone consultations with nursing home staff as required Conducts home visits as needed Collaborates with other IDT members and other providers to formulate and achieve care plan goals, meet emergent and acute needs of participants, and assure comprehensive and continuous care Ability to work sensitively and effectively with individuals of diverse and ethnic cultural backgrounds. Actively participates in family conferences and manages sensitive conversations related to medical care needs Manages the placement of clients in the hospital, skilled nursing facility and long-term care placement by participating in the approval, review and management of such placements Maintain positive relationship with hospitals and agencies that support community-based long-term care Ensures development and compliance with organizational policies and procedures and all applicable regulatory requirements and standards Develops written policies, protocols, and\or staff education designed to improve the quality of clinical care Serves as an active member of committees that require input regarding medical care or assigns an appropriate designee Provides medical evaluation, direction and guidance to PACE as required by law and consistent with CMS regulations Furnishes medical expertise, leadership and consultation regarding the design, implementation, and evaluation of clinical services within the context of organizational mission, vision and goals Collaborates with senior management to promote quality, efficiency and effectiveness of service. This includes responsibility for use of current clinical services, and the design of new services to reduce institutional utilization Recognizes trends in care provision/utilization and oversees appropriate utilization of medical and institutional services. Identifies negative trends and coordinates appropriate interventions that along with IDT will trigger a plan to manage them in a timely manner; develops quality calendar with Quality Specialist and reports out on results annually to Board of Directors. Recruits and provides ongoing supervision, mentorship and training of primary care physicians and nurse practitioners and provides clinical oversight and input into their periodic performance evaluations Creates and encourages the implementation of pathways or tools that assist the team in making sound clinical decisions regarding utilization of services Oversees the training of medical students, fellows, and research projects at or in conjunction with PACE-RI Demonstrates thorough knowledge of current concepts, evidenced based practice, theories, and practices to guide the clinicians and IDT in home and community-based care for the elderly and disabled adults Participates in the contract negotiations for the medical-related providers and evaluates the competence and quality of existing providers on a regular basis Serves as community liaison with physicians, hospitals, and other health care providers Interfaces actively with other PACE-RI physicians and medical directors Together with Senior Management, supports the IDT in reaching decisions via consensus according to PACE-RI policy and procedural guidelines Create and implement departmental audit system to identify areas of non-compliance and opportunities for quality improvement; use data to inform decision making and action steps. Responsible for leading and managing the strategic and operational aspects of pharmacy services, ensuring compliance with regulatory standards, and driving improvements in medication safety, quality, and efficiency. Demonstrates an understanding of the importance of clear, thorough documentation as crucial to good participant care; completes and enters accurate, thorough participant documentation in the electronic health record; enters documentation for assessments, orders, and notes within required timeframes. Performs other related duties as required and assigned. Required Skills & Abilities: Ability to maintain confidentiality Ability to prioritize tasks and meet project deadlines Proficiency with MS Office Suite or similar software Dependable and punctual with ability to maintain consistent attendance Ability to read, write and comprehend English Ability to maintain sound judgement under stress and communicate effectively Ability to research and analyze data, draw conclusions, and resolve issues Ability to read, interpret, and apply policies, procedures, laws, and regulations Ability to proficiently perform clinical/skilled tasks associated within scope of position Education Requirement: Doctorate, Required Physical Requirements: Physical ability to regularly stoop, bend, kneel, lift, stand, walk, stretch and reach for extended periods of time.Must be able to regularly lift objects up to 25 pounds and at times up to 35 pounds.Must be able to assist a 200-250 lb participant, using proper body mechanics.Must have hearing and vision abilities within normal range (corrected) to drive safely and/or to observe and communicate with participants.Must be able to navigate various departments of the organization's physical premises as well as related community care settings.Must be able to tolerate conditions typically associated within a medical office and/or home care setting including potential exposure to bloodborne pathogens and infectious diseases.Must be able to complete assignments in variable weather conditions and ever-changing and sometimes allergenic environments in participant homes, including extreme heat, humidity, dust, smoke, pet contamination, and cleaning supplies. Experience: 5 years primary care experience with senior population, Required 3-5 years of Staff management, budgetary and clinical management experience, Required Licensure & Certification Requirements: RI Doctor of medicine or osteopathy RI Controlled Substance Registration Position Requirements: CPR CertificationNPI NumberDEA Registration NumberDriver's License & access to reliable transportation: community-based travel required.

Under the supervision of the CEO of PACE the Chief Medical Officer provides general medical direction and supervision of the medical aspects of care for PACE-RI. In conjunction with the Chief of Clinical Services provides direction and supervision of related primary care, nursing, and allied health services. The Chief Medical Officer has authority over the quality improvement program within PACE and sets forth a philosophy of care through the development of protocols, education, and best practices. Job Duties/Responsibilities: Assumes overall accountability and responsibility for the medical care of the participants of PACE-RI. Provides direct primary care for an appropriate panel size of participants. Performs comprehensive history and physical on new enrollees within 30 days of enrollment Performs interval assessments on established participants, semi-annually or as directed. Evaluates and treats participants with episodic illnesses and informs IDT as to the chronic and acute care trajectory. Judiciously utilizes and oversees the use of specialist consultations as needed Admits participants to hospital, providing primary care attending responsibilities; and/or coordinates and manages care through pro-active collaboration with hospitalist, provides updates to the IDT on a regular basis, and assists with actively coordinating discharge planning with IDT Manages all care of participants in the nursing home, conducts regular visits, and performs telephone consultations with nursing home staff as required Conducts home visits as needed Collaborates with other IDT members and other providers to formulate and achieve care plan goals, meet emergent and acute needs of participants, and assure comprehensive and continuous care Ability to work sensitively and effectively with individuals of diverse and ethnic cultural backgrounds. Actively participates in family conferences and manages sensitive conversations related to medical care needs Manages the placement of clients in the hospital, skilled nursing facility and long-term care placement by participating in the approval, review and management of such placements Maintain positive relationship with hospitals and agencies that support community-based long-term care Ensures development and compliance with organizational policies and procedures and all applicable regulatory requirements and standards Develops written policies, protocols, and\or staff education designed to improve the quality of clinical care Serves as an active member of committees that require input regarding medical care or assigns an appropriate designee Provides medical evaluation, direction and guidance to PACE as required by law and consistent with CMS regulations Furnishes medical expertise, leadership and consultation regarding the design, implementation, and evaluation of clinical services within the context of organizational mission, vision and goals Collaborates with senior management to promote quality, efficiency and effectiveness of service. This includes responsibility for use of current clinical services, and the design of new services to reduce institutional utilization Recognizes trends in care provision/utilization and oversees appropriate utilization of medical and institutional services. Identifies negative trends and coordinates appropriate interventions that along with IDT will trigger a plan to manage them in a timely manner; develops quality calendar with Quality Specialist and reports out on results annually to Board of Directors. Recruits and provides ongoing supervision, mentorship and training of primary care physicians and nurse practitioners and provides clinical oversight and input into their periodic performance evaluations Creates and encourages the implementation of pathways or tools that assist the team in making sound clinical decisions regarding utilization of services Oversees the training of medical students, fellows, and research projects at or in conjunction with PACE-RI Demonstrates thorough knowledge of current concepts, evidenced based practice, theories, and practices to guide the clinicians and IDT in home and community-based care for the elderly and disabled adults Participates in the contract negotiations for the medical-related providers and evaluates the competence and quality of existing providers on a regular basis Serves as community liaison with physicians, hospitals, and other health care providers Interfaces actively with other PACE-RI physicians and medical directors Together with Senior Management, supports the IDT in reaching decisions via consensus according to PACE-RI policy and procedural guidelines Create and implement departmental audit system to identify areas of non-compliance and opportunities for quality improvement; use data to inform decision making and action steps. Responsible for leading and managing the strategic and operational aspects of pharmacy services, ensuring compliance with regulatory standards, and driving improvements in medication safety, quality, and efficiency. Demonstrates an understanding of the importance of clear, thorough documentation as crucial to good participant care; completes and enters accurate, thorough participant documentation in the electronic health record; enters documentation for assessments, orders, and notes within required timeframes. Performs other related duties as required and assigned. Required Skills & Abilities: Ability to maintain confidentiality Ability to prioritize tasks and meet project deadlines Proficiency with MS Office Suite or similar software Dependable and punctual with ability to maintain consistent attendance Ability to read, write and comprehend English Ability to maintain sound judgement under stress and communicate effectively Ability to research and analyze data, draw conclusions, and resolve issues Ability to read, interpret, and apply policies, procedures, laws, and regulations Ability to proficiently perform clinical/skilled tasks associated within scope of position Education Requirement: Doctorate, Required Physical Requirements: Physical ability to regularly stoop, bend, kneel, lift, stand, walk, stretch and reach for extended periods of time. Must be able to regularly lift objects up to 25 pounds and at times up to 35 pounds. Must be able to assist a 200-250 lb participant, using proper body mechanics. Must have hearing and vision abilities within normal range (corrected) to drive safely and/or to observe and communicate with participants. Must be able to navigate various departments of the organization's physical premises as well as related community care settings. Must be able to tolerate conditions typically associated within a medical office and/or home care setting including potential exposure to bloodborne pathogens and infectious diseases. Must be able to complete assignments in variable weather conditions and ever-changing and sometimes allergenic environments in participant homes, including extreme heat, humidity, dust, smoke, pet contamination, and cleaning supplies. Experience: 5 years primary care experience with senior population, Required 3-5 years of Staff management, budgetary and clinical management experience, Required Licensure & Certification Requirements: RI Doctor of medicine or osteopathy RI Controlled Substance Registration Position Requirements: CPR Certification NPI Number DEA Registration Number Driver's License & access to reliable transportation: community-based travel required.

Job Title: Associate Medical Director Reports to: Site Medical Director Department: Medical FLSA Status: Exempt Job Grade: General Responsibilities: The Associate Medical Director works collaboratively with the site management team, including the Medical Director, to support the oversight and delivery of high-quality medical services at a designated Thundermist Health Center location. This role includes providing direct clinical care in alignment with Thundermist policies, procedures, and mission. The Associate Medical Director plays a key leadership role in provider performance, clinical operations, patient care quality, and teamwork across departments. Additionally, this position serves as a liaison between the health center and the broader medical community, supporting clinical risk management and fostering strong provider engagement and performance. Qualifications: Required: M.D., D.O., Nurse Practitioner, or Certified Nurse Midwife with board certification in Family Medicine. Minimum of three (3) years post-residency clinical practice experience in primary care, or five (5) years of practice experience for APRNs. Full, unrestricted license to practice medicine in the State of Rhode Island. Preferred: Interest or experience in OB/GYN care is beneficial but not required. Clinical scope flexibility is supported, as the family medicine team and midwifery group provide collaborative care. Significant Job Functions: Planning & Leadership Participate collaboratively on the Thundermist Clinical Leadership Team to review, inform, and implement clinical practices and organizational policies. Organization & Operations Work with the Chief Operating Officer and Patient Care Director to optimize clinical productivity, efficiency, and patient access. Support smooth clinical workflows and operational alignment across departments. Staffing & Provider Support Participate in credentialing, job description development, and evaluation standards for medical staff. Interview provider candidates and provide input into hiring decisions. Conduct and assist in annual performance evaluations for site medical providers. Supervise and support medical providers through audits, peer reviews, coaching, and feedback. Participate in provider disciplinary actions and terminations in collaboration with senior executives and Human Resources. Monitoring & Quality Oversight Review, interpret, and assess clinical performance data. Provide oversight to OB/GYN and Pediatric services delivered at the site. Review practice management data and performance measures with leadership. Review patient satisfaction surveys and manage higher-level patient concerns or complaints related to provider care. Ensure adherence to clinical standards and promote continuous quality improvement. Physical Effort/ Environment: This position requires routine physical effort consistent with providing direct patient care, including performing examinations and procedures. Some activities may require fine motor dexterity or positioning of patients. Reasonable accommodations may be made to support physical ability needs. The work environment is clinical, fast-paced, and patient-centered. Work Schedule Demands: Work Schedule Demands Full-time, 40 hours per week. Includes approximately: 25 hours clinical 5 hours administrative 10 hours of administrative work associated with the role of Associate Medical Director Communication Skills: Exceptional verbal and written communication skills required. Proficiency in clinical and medical terminology. Ability to provide clear, compassionate, and supportive communication with patients, clinical staff, and community partners. Skilled in conflict resolution, particularly when coaching providers through burnout or addressing performance concerns. Must be able to communicate confidential and sensitive matters professionally. Confidentiality of Information: Thundermist is dedicated in securing the privacy and confidentiality of protected health information under the Health Insurance Portability and Accountability Act. It is the responsibility of all employees to comply to state and federal guidelines in accessing sensitive information. The incumbent must apply strict confidentiality. ADA & EEOC Statement: Thundermist is dedicated to the goal of building and maintaining a diverse and inclusive workforce committed to caring for patients in a manner that is respectful of cultural difference. We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, gender identity, national origin, disability status, protected veteran status, or any other characteristic protected by law.