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Center Clinical Director, Associate
Chenmed
Public health director job in Columbus, OH
We're unique. You should be, too.
We're changing lives every day. For both our patients and our team members. Are you innovative and entrepreneurial minded? Is your work ethic and ambition off the charts? Do you inspire others with your kindness and joy?
We're different than most primary care providers. We're rapidly expanding and we need great people to join our team.
The Clinical Director will directly supervise and train primary care providers (PCPs) in his/her assigned center. The incumbent in this role is accountable for maximizing overall core model execution, including improving clinical quality, efficiency, outcomes, and clinician/patient satisfaction. In addition to being accountable for the overall clinical outcomes of his/her assigned center, they will have a portion of their time allocated to direct patient care as a PCP and/or other clinical duties (amount dependent on number of direct reports). The remainder of their time is allocated to leadership responsibilities, including PCP performance, engagement, and building a strong clinical-operations synergy and culture. The allocation of time is dependent on several factors, including PCP capacity, market needs, size of centers, patient membership, and Market Clinical Director direction.
ESSENTIAL JOB DUTIES/RESPONSIBILITIES:
Independently provides care for patients with acute and chronic illnesses encountered in older adult patients.
Takes full accountability for patient care and outcomes and appropriately seeks consultation from specialists when needed, though will still stay involved in, and be responsible for, the detailed care of the patient.
Engages with the hospitalist whenever one of their patients is in the hospital (regardless of whether the hospitalist works for ChenMed or not).
Responsible for assessment, diagnosis, treatment, management, education, health promotion and care coordination and documentation for patients with acute and complex chronic health needs.
Leads their care team consisting of care promoter (medical assistant), care facilitator, and care coordinator for patients able to come to the office.
For patients that are unable to come to the office-in hospital, SNF, LTC or homebound, engages with the transitional care team and others including case managers, acute and transitional-care physicians, and other resources that may be available depending on the market.
Leads Super Huddle (SH) and Transforming Care Meeting (TCM) weekly, as well as supports Center Manager/Center General Manager center clinical leader and/or market clinical leader is not available, based on guidance from Market Chief Medical Officer. Fills in as needed for center clinical leadership needs, including monitoring daily center census as part of joint center accountability for outcomes.
Plays an active role in the management of their center and helps cover for other providers who may be out for various reasons. It is also expected that each Clinical Director will take an active role as needed in recruiting patients for the center and recruiting and interviewing additional providers for the company.
Managing, mentoring and coaching PCPs in his/her assigned center to deliver outstanding clinical outcomes, including sampling other PCP's daily huddles within their center
Leadership rounding with the PCPs (reduced involvement of market clinical leader)
Partnering with Center Operations Director/Market General Manager to drive continued improvement of center financial performance, and helping increase center membership
Performs other duties as assigned and modified at manager's discretion.
KNOWLEDGE, SKILLS AND ABILITIES:
Proficient in Microsoft Office Suite products including Word, Excel, PowerPoint and Outlook, plus a variety of other applications used in the company
Ability and willingness to travel locally as needed in their market, if applicable, nationally for initial training (2 weeks) and then occasionally regionally and nationally for recruiting or training purposes
Fluency in English, verbal and written. There may be jobs in some centers that require fluency in other languages, and this will be made known at the time of application.
This job requires use and exercise of independent judgment
EDUCATION AND EXPERIENCE CRITERIA:
MD or DO in Internal Medicine, Family Medicine, Geriatrics, or similar specialty required
Current, active MD licensure in State of employment is required
A minimum of 1-year clinical experience in geriatric, adult or family practice setting preferred, with Lead PCP ideally being a ChenMed PCP Partner
Completion of Chen Medical training, including Masterful Conversations and meeting facilitation, as part of the individual development plan
Board certification in Internal Medicine, Family Medicine, Geriatrics or similar specialty is preferred, Board Eligibility is required
Once Board certified, PCP will maintain board certification in their terminal specialty by doing necessary MOC, CME and/or retaking board exams as required
Must have a current DEA number for schedule II-V controlled substances
Basic Life Support (BLS) certification from the American Heart Association (AMA) or American Red Cross required w/in first 90 days of employment
PAY RANGE:
$238,832 - $341,189 Salary
EMPLOYEE BENEFITS
******************************************************
We're ChenMed and we're transforming healthcare for seniors and changing America's healthcare for the better. Family-owned and physician-led, our unique approach allows us to improve the health and well-being of the populations we serve. We're growing rapidly as we seek to rescue more and more seniors from inadequate health care.
ChenMed is changing lives for the people we serve and the people we hire. With great compensation, comprehensive benefits, career development and advancement opportunities and so much more, our employees enjoy great work-life balance and opportunities to grow. Join our team who make a difference in people's lives every single day.
Current Employee apply HERE
Current Contingent Worker please see job aid HERE to apply
#LI-Onsite
$79k-125k yearly est. 1d ago
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Associate Medical Director
National Staffing Solutions 4.2
Public health director job in Columbus, OH
Permanent Associate Medical Director Board Certified in Family Medicine / Internal Medicine
FQHC Setting
What we Offer:
Schedule: M- F 8am to 5pm, No Weekends
Competitive Pay: $250k to $270k. depends on experience
Sign On Bonus: $30,000
Full Benefits Package - Medical, dental, vision, disability & life insurance. 401(k).
What the Associate Medical Director will Do:
80% Clinical / 20% Administration
Supervise and coach fellow providers in how to provide excellent primary care / urgent care and community care
This is a FQHC setting must be comfortable with Community Medicine
Partake in leadership meeting and also act as an ambassador to community based organizations, hospitals, and payers
Requirements of the Associate Medical Director:
5+ Years clinical experience / Administrative leadership experience needed
Must have 2 -3 recent years experience in primary care medicine
Active and unrestricted medical or nursing license in the state required
Background in working for a clinic or community based inpatient setting a plus
Must be ok prescribing opioids
$250k-270k yearly 3d ago
Director of Nursing (DON)
Jag Healthcare 4.3
Public health director job in Marion, OH
JAG Healthcare Marion is now scheduling RN/DON interviews as we are searching for our next long-term Director of Nursing (DON). JAG Healthcare Marion is seeking a strong, energetic Director of Nursing (DON) to work alongside their long-time Administrator to help maintain the excellent care culture that is established there. The Director of Nursing (DON) should be a compassionate RN who has at least five years of experience as a Director of Nursing or in a comparable position.
Recognizing that there is much opportunity in our healthcare employment market for potential applicants, we are seeking candidates interested in employment stability, flexible scheduling, and the desire to secure a long-term employment opportunity. Being a smaller facility, there is a balance in the workload and exceptional patient care ratios. Leadership staff are expected to lead by example and be team-oriented to ensure the highest level of quality care and service can be delivered to our residents.
JAG Healthcare Marion has only 45 beds, giving it a homelike feel for our residents. This quaint environment also provides our nurses the opportunity to spend meaningful time with their residents without rushing from one room to the next. This is one of the most common positive comments that we hear from nurses coming from larger healthcare facilities.
If you are looking for a rewarding job as a Director of Nursing (DON) that allows you to build meaningful connections with residents while improving their quality of life, this job could be for you!.
Skills & Responsibilities (include but not limited to):
Direct, oversee, coordinate & evaluate nursing care services provided to the residents.
Emphasis on education and staff development to grow and develop the nursing team
Ensuring compliance with all State & Federal guidelines.
Ensuring all confidentiality and privacy rights of residents are observed & enforced.
Overseeing State Survey complaints, investigations, and resolutions.
Develop and enforce policies aiming for legal compliance and high-quality standards.
Develop objectives and long-term goals for the department.
Guide staffing procedures.
Excellent ability to lead and develop personnel.
Willingness for continual education to keep up with changing standards in nursing administration.
Exceptional communication and problem-solving skills, with a focus on customer service.
Strong focus on Quality Assurance and Performance Improvement
Team-oriented with the ability to work in a collaborative interdisciplinary setting
Requirements for the position include:
Licensed as a Registered Nurse (RN) in the State of Ohio and in good standing with the Board of Nursing.
Must be familiar with and be able to follow all established Federal, State and Local rules, regulations, and guidelines.
Must understand and be able to implement and follow the facility policy/procedure.
Proven ability to lead a clinical team to successful clinical outcomes.
Minimum of 5 years DON experience, or comparable position (required)
Minimum of 5 years of acute care, long-term care, or geriatric supervisor and management experience in a Medicaid/Medicare certified facility (required).
Experience working with cognitive deficits and behavioral health care (plus).
Successful completion of the Infection Preventionist Training (preferred, but willing to assist with certification)
Strong focus on inventory and supply chain management
At JAG Healthcare, we offer a homelike family family-oriented atmosphere, striving to create a lifetime of balance for our residents, employees, and the communities in which we serve
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$63k-79k yearly est. 4d ago
Per Diem Health Plan UM Medical Director
Massachusetts Eye and Ear Infirmary 4.4
Remote public health director job
Site: Mass General Brigham Incorporated
Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham.
Job Summary
Mass General Brigham Health Plan UM Medical Director
Qualifications
Education: MD or DO required
Licenses and Credentials:
Physician - Massachusetts active full license required
Experience:
5+ years of Health Plan UM experience
at least 5 years of clinical practice experience
Knowledge, Skills and Abilities:
Utilization Management experience
Excellent written and oral communications skills
Proficient in basic computer skills, use of EHR's, digital tools
Multitasking abilities
Adaptable to change due to business growth
Job Description:
Handles utilization management initial determinations, appeals and grievances within the scope of their expertise as defined by Medicare, MassHealth, NCQA and the Division of Insurance and within the compliance requirements of key regulatory and accreditation entities
Use CMS, state and internal medical necessity policies to guide MN determinations
Complete peer to peer case discussions with requesting providers as assigned
Refer to IRO/external review if specialist match or expertise is needed
Interact, communicate and collaborate with network and community physicians, hospital leaders and other vendors regarding care and services for enrollees
Monitors performance metrics to identify areas for continuous improvement and ensure compliance
Establishes and maintains positive relationships with colleagues and customers and gains their trust and respect
Ensure diversity, equity and inclusion are integrated as a guiding principle
Other duties as assigned with or without accommodation
Additional Job Details (if applicable)
Primarily remote position
M-F 830-5pm EST
Ensures that all assigned work is completed within regulatory timelines
Checks and addresses assigned work queues, email, Teams messages during assigned work hours
Remote Type
Remote
Work Location
399 Revolution Drive
Scheduled Weekly Hours
0
Employee Type
Regular
Work Shift
Day (United States of America)
EEO Statement:
Balance Sheet Cost Centers is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veteran's Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants who require accommodation in the job application process may contact Human Resources at **************.
Mass General Brigham Competency Framework
At Mass General Brigham, our competency framework defines what effective leadership “looks like” by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.
$206k-287k yearly est. Auto-Apply 13d ago
Medical Director, Cardiometabolic Clinical Care Model Design and Client Engagement
Teladoc Health Medical Group 4.7
Remote public health director job
Join the team leading the next evolution of virtual care.
At Teladoc Health, you are empowered to bring your true self to work while helping millions of people live their healthiest lives.
Here you will be part of a high-performance culture where colleagues embrace challenges, drive transformative solutions, and create opportunities for growth. Together, we're transforming how better health happens.
Summary of Position
Teladoc Health is seeking an experienced physician to serve as Medical Director, Cardiometabolic Clinical Care Model Design and Client Engagement. This physician leader will serve in a highly cross-functional role instrumental in shaping the future of cardiometabolic care at Teladoc Health, particularly within our U.S. Group Health Business, advancing clinical excellence across existing chronic condition management solutions while building and scaling novel approaches. This role will continue to champion seamless integration of cardiometabolic care across our expansive ecosystem of virtual primary care, urgent care, mental health, expert medical/specialty care, and more.
This is an individual contributor leadership position requiring strong clinical expertise in cardiometabolic care and the ability to work strategically in the complex and rapidly evolving virtual care/digital health space. Success in this role requires close cross-functional collaboration with diverse stakeholders to enhance care delivery models, achieve best-in-class clinical outcomes, and optimize return on investment. The candidate will support value-based care partnerships and drive clinical research to strengthen the evidence base for virtual cardiometabolic care. Additionally, this physician leader must be able to translate these efforts into client-facing strategies, partnering with employers and payers to help them understand and achieve better health outcomes for their populations.
Essential Duties and Responsibilities
Serve as the clinical lead for designing cardiometabolic care models across new and existing capabilities within the U.S. Group Health business.
Lead clinical and cross-functional teams to design, pilot, and scale innovative integrated cardiometabolic care models, working closely with front-line providers and care teams.
Translate population health data and risk stratification into actionable program strategies.
Define success metrics-including clinical outcomes and financial ROI-and develop strategies for sustained impact.
Work closely with internal teams-including sales, marketing, and client-facing groups-providing clinical expertise for key presentations and client discussions.
Represent the organization externally on topics related to chronic condition management and cardiometabolic care innovation.
Develop and refine chronic condition management frameworks, measures, and reporting aligned with the Institute for Healthcare Improvement Quadruple Aim and Institute of Medicine quality domains: safety, effectiveness, patient-centeredness, efficiency, timeliness, and equity.
Co-lead formal quality improvement projects using the Model for Improvement with a focus on process and outcome metrics and leveraging statistical process control (SPC) where appropriate.
Partner with our Clinical Research team to generate evidence and insights for white papers and peer-reviewed publications demonstrating the impact of our cardiometabolic solutions.
The time spent on each responsibility reflects an estimate and is subject to change dependent on business needs.
Supervisory Responsibilities
No
Required Qualifications
MD/DO in Internal Medicine, Family Medicine, or a cardiometabolic specialty; active medical license preferred
At least 5+ years of post-residency or fellowship clinical experience
Experience in virtual care, digital health, or healthcare technology, with the ability to adapt to rapid change and ambiguity.
Demonstrated expertise in delivering evidence-based clinical care model design, clinical quality improvement, outcome measurement.
Exemplary written and verbal communication skills, including the ability to explain complex clinical concepts to non-clinical audiences.
Proven ability to collaborate effectively across clinical and non-clinical teams, including operations, product, engineering, marketing, commercial, and other functions in a highly matrixed environment.
Strong prioritization, time management, and organizational skills, with meticulous attention to detail. Ability to thrive in fast-paced, dynamic environments with multiple competing priorities and deadlines.
Preferred Qualifications
Experience in dedicated virtual care/digital health organizations focused on cardiometabolic conditions.
MBA/MPH and/or advanced quality improvement training preferred.
Demonstrated experience delivering virtual care, particularly in primary care and cardiometabolic management beyond the COVID-19 pandemic.
Expertise in value-based care delivery with track record of maximizing clinical outcomes while managing total cost of care.
Required license or credential needed to perform job: MD/DO
The above qualifications, knowledge, experience, and/or background are expected but not required for this role.
Work Environment
☐ Office ☒ Remote ☐ Hybrid (Office & Remote)
Travel: ≥10%
Travel percentage reflects an estimate and is subject to change dependent on business needs.
The base salary range for this position is $210,000 - $240,000. In addition to a base salary, this position is eligible for a performance bonus and benefits (subject to eligibility requirements) listed here: Teladoc Health Benefits 2026. Total compensation is based on several factors including, but not limited to, type of position, location, education level, work experience, and certifications. This information is applicable for all full-time positions.
As part of our hiring process, we verify identity and credentials, conduct interviews (live or video), and screen for fraud or misrepresentation. Applicants who falsify information will be disqualified.
Teladoc Health will not sponsor or transfer employment work visas for this position. Applicants must be currently authorized to work in the United States without the need for visa sponsorship now or in the future.
Why join Teladoc Health?
Teladoc Health is transforming how better health happens. Learn how when you join us in pursuit of our impactful mission.
Chart your career path with meaningful opportunities that empower you to grow, lead, and make a difference.
Join a multi-faceted community that celebrates each colleague's unique perspective and is focused on continually improving, each and every day.
Contribute to an innovative culture where fresh ideas are valued as we increase access to care in new ways.
Enjoy an inclusive benefits program centered around you and your family, with tailored programs that address your unique needs.
Explore candidate resources with tips and tricks from Teladoc Health recruiters and learn more about our company culture by exploring #TeamTeladocHealth on LinkedIn.
As an Equal Opportunity Employer, we never have and never will discriminate against any job candidate or employee due to age, race, religion, color, ethnicity, national origin, gender, gender identity/expression, sexual orientation, membership in an employee organization, medical condition, family history, genetic information, veteran status, marital status, parental status, or pregnancy). In our innovative and inclusive workplace, we prohibit discrimination and harassment of any kind.
Teladoc Health respects your privacy and is committed to maintaining the confidentiality and security of your personal information. In furtherance of your employment relationship with Teladoc Health, we collect personal information responsibly and in accordance with applicable data privacy laws, including but not limited to, the California Consumer Privacy Act (CCPA). Personal information is defined as: Any information or set of information relating to you, including (a) all information that identifies you or could reasonably be used to identify you, and (b) all information that any applicable law treats as personal information. Teladoc Health's Notice of Privacy Practices for U.S. Employees' Personal information is available
at this link
.
$210k-240k yearly Auto-Apply 13d ago
Regional Medical Affairs Director - Gulf Coast
Xeris Pharmaceuticals 4.2
Remote public health director job
The Regional Medical Affairs Director (RMAD) is a member of a field-based team which is an extension of the US Regional Medical Affairs organization and is responsible for developing and enhancing professional relationships with specified key thought-leaders (KTLs), institutions, and organizations in their assigned geographical region. A RMAD focuses on medical & scientific engagement with identified healthcare and decision maker stakeholders by providing medical and scientific support via scientific exchange, addressing customers medical and scientific informational needs, and collaborating in mutually identified areas of medical, education, clinical research, and real-world experience/evidence. RMADs are recognized as an internal subject matter expert and provide appropriate medical and scientific support for internal teams as identified.
Candidate to reside in: Houston, TX; San Antonio, TX; New Orleans, LA; or Jackson, MS
Territory covers: TX, LA, MS
Responsibilities
Fostering mutually collaborative relationships with institutions, Centers of Excellence, thought leaders (TLs) and key decision makers across the healthcare ecosystem in the areas of medical, education, clinical research, and real world experience.
Provide medical information through scientific exchange in a fair-balanced manner and clinical/scientific support as identified or requested in addressing the informational needs of the healthcare community, as well as responding to unsolicited requests for pipeline or off-label information.
Delivering medical presentations to diverse healthcare professional (HCP) audiences including healthcare decision makers, professional medical societies, and identified advocacy groups.
Providing scientific and liaison support related to Xeris clinical research activity, including thought leader and investigator engagement and follow-up, and facilitation of unsolicited requests for interactions related to Investigator Initiated Studies (IISs).
Maintaining cross-functional collaboration with internal & external field teams to provide scientific expertise and medical support within Medical Affairs, Clinical Development, Commercial, and other internal stakeholders, etc.
Obtaining, assimilating, organizing, and reporting appropriate competitive and scientific intelligence in a concise, clear manner, compliant with all applicable Xeris policies, procedures, and processes
Attending & participating in medical/scientific meetings and conferences for the purpose of gaining scientific insights, collecting emerging scientific data, identifying healthcare trends, and supporting the scientific exchange and communication related to Xeris therapeutic areas of interest and research & development
As identified, contribute to internal training for headquarter- and field-based teams and supporting speaker training initiatives.
Assisting with the implementation and engagement of TL participation in advisory boards, consultant meetings and other scientific meetings consistent with all Xeris policies, procedures, and processes.
Maintain clinical/scientific expertise and providing strategic insights into emerging scientific data and healthcare trends.
Collaborating with TLs and Xeris Medical Communications to support the development of appropriate publications and related medical communications.
Participate in assigned Medical Affairs projects, initiatives, and activities as identified and requested.
Performing and completing administrative responsibilities, including reporting requirements in a timely fashion
Qualifications
Advanced degree (MD, PhD, PharmD, DNP) in a related discipline strongly preferred
Less than 2 years of experience [Entry level as Associate Director]; 2+ years of experience [Entry Level as Director] of previous Field Medical or Medical Affairs pharmaceutical industry [post-doctoral pharmaceutical industry training via residency or fellowship also welcomed]
Active clinical care, clinical research, or academia experience preferred
Clear understanding of regional medical practice, clinical decision-making and healthcare systems affecting patient care.
Demonstrated strong understanding of clinical research trial and/or related laboratory research design and execution
Extensive knowledge of Endocrinology, including Cushing's Disease and field medical affairs is strongly preferred.
Competencies: Customer Service focus, Teamwork & Collaboration, Written and Verbal Communication skills, Presentation skills, Time Management skills, Self-Starter.
Working Conditions: Position may require periodic evening and weekend work, as necessary to fulfill obligations. Periodic overnight travel. Approximately 60% overnight travel
The level of the position will be determined based on the selected candidate's qualifications and experience.
#LI-REMOTE
As an equal employment opportunity and affirmative action employer, Xeris Pharmaceuticals, Inc. does not discriminate on the basis of race, color, religion, sex, gender identity, sexual orientation, national origin, age, disability, veteran status, genetics or any other characteristic protected by law. It is our intention that all qualified applications are given equal opportunity and that selection decisions be based on job-related factors.
The anticipated base salary range for this position is $170,000 to $225,000. Final determination of base salary offered will depend on several factors relevant to the position, including but not limited to candidate skills, experience, education, market location, and business need. This role will include eligibility for bonus and equity. The total compensation package will also include additional elements such as multiple paid time off benefits, various health insurance options, retirement benefits and more. Details about these and other offerings will be provided at the time a conditional offer of employment is made. Candidates are always welcome to inquire about our compensation and benefits package during the interview process.
NOTE: This job description is not intended to be all-inclusive. Employee may perform other related duties as negotiated to meet the ongoing needs of the organization.
Direct Employers Posting: Houston, TX; New Orleans, LA; Jackson, MS.
$170k-225k yearly Auto-Apply 9d ago
Medical Director-Physical Health (Full-time Remote, North Carolina Based)
Alliance 4.8
Remote public health director job
The Physical Health Medical Director plays a key role within the Physical Health Medical Management Team, providing clinical oversight, medical expertise, and operational support for physical health services. This position ensures high quality, evidence based medical review processes and supports organizational goals related to clinical quality, utilization management, and care coordination.
This position will allow the successful candidate to work primarily remote. While there is no expectation to be in the office routinely, the selected candidate may be required to report on-site as needed. It's strongly preferred that the selected candidate reside in North Carolina or be willing to relocate. This position may be required to work weekends and holidays based on organizational and operational requirements.
Responsibilities & Duties
Clinical Oversight & Medical Review
Provide expert guidance and oversight for physical health service requests, including authorization of services and determination of appropriate level of care
Ensure the integrity and quality of utilization management activities, including initial reviews, concurrent reviews, appeals, and level of care determinations for inpatient and outpatient services
Participate in internal reviews of inpatient and outpatient clinical case types to ensure compliance with regulatory, accreditation, and organizational standards
Review Approval and Denial of Service and Level of Care Requests
Apply medical necessity criteria utilizing review criteria hierarchy for level of care and services regarding type, amount, and duration of service. Complete expected case volume as expected by the department
Process Adherence, Quality & Efficiency
Follow department processes-as defined by approved Alliance policies, desk procedures, and workflows referenced on the Alliance Grid and in the Medical Director OneNote-to complete timely utilization reviews in Alliance's UM platform and perform tasks efficiently
Apply established workflows and maintain quality case reviews to ensure consistent decision making, documentation accuracy, and adherence to regulatory compliance
Operational & Committee Support
Support the Clinical Operations Department through active participation in organizational committees, including but not limited to Clinical Quality Review, Transition of Care Rounds, Overturn Committee
Provide clinical guidance and leadership to promote collaboration between medical, behavioral, and care management teams
External Engagement
Participate in mediation activities and Office of Administrative Hearing (OAH) processes as required, providing clinical expertise and documentation support
Additional Responsibilities
Maintain awareness of regulatory requirements, utilization management guidelines, and emerging trends affecting utilization management and physical health services
Contribute to process improvement initiatives aimed at enhancing clinical quality, efficiency, and member outcomes
Support cross functional teams with medical expertise, as needed
Provide consultation, training, and education to staff and community partners on relevant topics as needed
Train and mentor peers within the Medical Management team and assist with onboarding PH Medical Director new hires as needed
Maintain a Positive Environment
Work with Human Resources and Medical Team to attract, maintain, and retain a highly qualified and well-trained workforce
Actively establish and promote a positive, diverse, and inclusive working environment that builds trust with teammates
Ensure all staff are treated with respect and dignity
Ensure standards are transparent and applied consistently, impartially, and ethically over time and across all staff members
Minimum Requirements
Education & Experience
Graduation from an accredited Medical School. M.D./D.O. degree is required and board certification in a relevant field. At least four (4) years of postgraduate clinical experience and two (2) or more years of managed care and utilization management experience are required.
Special Requirement
Current, active, and unrestricted license to practice medicine in North Carolina or meets qualifications to obtain a North Carolina Medical License with Board certification for appropriate field of Medicine (American Board of Family Medicine or American Board of Internal Medicine).
Knowledge, Skills, & Abilities
Knowledge of the information and techniques needed for diagnosis and treatment of medical issues, including symptoms, treatment alternatives, drug properties and interactions, and preventive health-care measures
Knowledge of Managed Care Principles
Knowledge of recent developments in the field of medicine
Microsoft Office Skills
Ability to speak with colleagues about treatment concerns, complex case issues and best practice recommendations
Utilization Management experience
Salary Range
$211,172 - $269,245/Annually
Exact compensation will be determined based on the candidate's education, experience, external market data and consideration of internal equity
An excellent fringe benefit package accompanies the salary, which includes:
Medical, Dental, Vision, Life, Long Term Disability
Generous retirement savings plan
Flexible work schedules including hybrid/remote options
Paid time off including vacation, sick leave, holiday, management leave
Dress flexibility
$211.2k-269.2k yearly 8d ago
Oncology Clinical Development Medical Director (Development Physician, IOD)
Astellas Pharma 4.9
Remote public health director job
Do you want to be part of an inclusive team that works to develop innovative therapies for patients? Every day, we are driven to develop and deliver innovative and effective new medicines to patients and physicians. If you want to be part of this exciting work, you belong at Astellas!
Astellas Pharma Inc. is a pharmaceutical company conducting business in more than 70 countries around the world. We are committed to turning innovative science into medical solutions that bring value and hope to patients and their families. Keeping our focus on addressing unmet medical needs and conducting our business with ethics and integrity enables us to improve the health of people throughout the world. For more information on Astellas, please visit our website at **************** .
This position is based in Northbrook, Illinois. Remote work from certain states may be permitted in accordance with Astellas' Responsible Flexibility Guidelines. Candidates interested in remote work are encouraged to apply.
**Purpose and Scope:**
+ Responsible for overseeing the design and delivery of trials within a given late phase program or multiple early-phase programs in the Immuno-Oncology group.
+ Reports to the Medical Lead/disease area strategy head for the given program(s) and is accountable for defining the strategy and execution of assigned trials.
+ Clinical team leader with clear understanding of areas of responsibilities and accountabilities of the role. Team player who is comfortable in situations where the role serves as a consultant and support to other functions and particularly the asset area. Understands the criticality of information and knowledge management, partnership and collaboration required in drug development.
**Essential Job Responsibilities:**
+ Collaborates effectively with key internal and external stakeholders as a member of the asset team and leader of the clinical study team to advance one or more clinical trials. Serves as Medical Monitor w/ responsibility for safety monitoring.
+ Ensures patient safety on clinical study is maintained. Generates safety related documents, such as medical monitoring reports and the safety database, to ensure that the reporting of SAEs is current and complete.
+ Collaborates closely with safety officer in writing and/or reviewing Safety Narratives, Investigator Letters, and other safety documentation for site-reported safety events.
+ Coordinates with Safety Officer on program for appropriate benefit-risk assessments, planning FIH study dose selection and escalation path for early-phase programs, safety management on trials, provides clinical input and review of clinical documents, statistical analysis plans, interim and final analyses on trials, publications, CSRs, DSURs and other critical documents.
+ Able to assimilate Research, Clinical Pharmacology, Biomarker, medical safety, Toxicology (early phase programs) regulatory, biostatistics, medical affairs, Health Economics, commercial perspectives into clinical development strategies and trial designs.
+ Responsible for managing the process of development of protocol and necessary regulatory documents.
+ Accountable and responsible for development and implementation, and execution of clinical trials as part of a large complex late phase (post POC, established market) program or a group of earlier stage programs, in alignment with Asset and overall clinical strategy.
+ In late phase program serves as the Lead for an indication specific clinical development team and is responsible and accountable for both strategy and execution of the clinical development plan for that indication or line of therapy.
+ In earlier phases, serves as the clinical lead for the entire clinical development strategy and execution for a given program.
+ Acquires public knowledge regarding therapeutic landscape, potential competitor products and serves as clinical voice regarding the potential for impact on planned clinical, medical affairs and commercial strategies.
+ Creates and maintains scientific/clinical networks and seeks external opinion leader as appropriate. Serve as the clinical interface during clinical advisory boards, investigator meetings, and interactions with opinion leaders. Serves as the clinical interface in regulatory authority interactions.
+ Accountable for clinical development milestones for their given trials. Supports Medical lead and Asset team at governance meetings and can present the clinical development plan in a succinct and clear manner at such meetings.
+ Works with Development Scientists and Clinical Operation Leads to ensure efficient and streamlined execution of clinical trials and acquisition and interpretation of high-quality clinical data to inform program-level decision making and overall development strategies.
+ Designs scientifically rigorous, cost-effective, and patient-centric clinical trials in accordance with the Clinical development Plan. Accountable for Clinical trial scope development and authoring of the protocol, IB, ICF as appropriate, in coordination with development scientists, clinical operations, medical writing and regulatory.
+ Responsible for keeping medical lead, asset lead and Development Head informed on progress of trials, risks, planned/required mitigations, and changes to timelines and budgets.
+ Supports clinical development related initiatives as needed. Leads and/or participates in scientific and medical training to other team members and external clients, investigators, and other site staff as it pertains to assigned studies.
**Qualifications:**
**Required**
+ MD or MD/PhD with oncology fellowship complete. Board certified with patient treatment experience beyond fellowship preferred.
+ Must have 5 years of pharmaceutical industry or academia experience specifically in clinical trial design and execution in a bio-pharmaceutical development organization or a balance of experience at an academic institution and a pharmaceutical company.
+ Proven record of designing clinical trials that can produce high quality data in a timely manner for decision making.
+ Documented experience planning and managing clinical trials, serving as medical monitor, managing trial execution in coordination with clinical operations.
+ Excellent verbal and written communication skills in English.
+ Experience working in global teams and a global matrixed, remote working environment.
+ Aware of cultural diversity and how to influence and manage in a multi-cultural organization.
+ Highest level of scientific integrity and impeccable work ethics
**Preferred:**
+ Extensive experience in gastroesophageal or thoracic oncology or immuno-oncology in solid tumors
+ Prior clinical research experience in an academic setting
+ Experience in all phases of Clinical Development and interfaces with Drug Discovery through Marketing.
+ Direct experience leading global regulatory marketing authorization submissions and defense of those submissions
**Salary Range:**
$215,600 - $338,800 (Final compensation will be determined based on a variety of factors, including but not limited to skills, experience and organizational equity considerations)
**Benefits:**
+ Medical, Dental and Vision Insurance
+ Generous Paid Time Off options, including Vacation and Sick time, plus national holidays including year-end shut down
+ 401(k) match and annual company contribution
+ Company paid life insurance
+ Annual Corporate Bonus and Quarterly Sales Incentive for eligible positions
+ Long Term Incentive Plan for eligible positions
+ Company fleet vehicle for eligible positions
+ Referral bonus program
Category Oncology Development
Astellas is committed to equality of opportunity in all aspects of employment.
EOE including Disability/Protected Veterans
$215.6k-338.8k yearly 14d ago
Veterinary Group Medical Director
Bluepearl 4.5
Remote public health director job
If you are a current associate, you will need to apply through our internal career site. Please log into Workday and click on the Jobs Hub app or search for Browse Jobs.
BluePearl is seeking an experienced, motivating, and driven clinical leader to join our team as a Group Medical Director - East Division. This is a remote position overseeing multiple hospital locations, with up to 60% overnight travel required.
The Group Medical Director (GMD) has medical oversight of multiple markets within the organization with combined revenues of up to $150MM.
The incumbent has the ultimate responsibility for translation of organizational objectives into market-specific objectives that instill a clinician-driven culture, promote clinician engagement and retention, and yield strong fiscal performance. A GMD frequently travels to hospitals to evaluate and mentor medical leaders and address concerns. The role partners with other members of the field leadership team to ensure a balanced representation of medical quality and financial considerations and the people & organization department to champion consistency in a high performance and engaged workforce united in being BluePearl.
As a GMD, you will:
Identify, oversee and develop medical leaders (Medical Directors and their ER Service Team Leads) to ensure optimal clinician productivity and engagement. Responsible for creating a clinician-driven culture in assigned markets.
Serve as high-level representative and champion of BluePearl mission and vision in all interactions within the organization and external veterinary community.
Partner with field leaders to effectively communicate and cascade key initiatives impacting medical staff.
Foster a collaborative and trusting relationship between the support team and hospitals.
Partner with field leaders to ensure appropriate productivity levels and growth plans for clinicians and hospitals, including maximizing technical teams.
Monitor reports on operating costs within functional areas. Alerts hospital leaders of cost and labor over run. Partners with field leaders, finance and P&O to assess concerns and implement solutions.
Own the success of on-site visit process for DVM candidates in assigned markets, ensures onboarding and mentoring of new BluePearl Clinicians through BluePearl Mentorship Program.
Ensure standards for medical quality, patient safety reporting, equipment, and clinician productivity/performance are met.
Partner with assigned Vet Relations team to collaborate on pDVM referral strategies that impact assigned markets.
Oversee and encourage support of continuing education programs across assigned markets and ensures programs sufficiently develop and engage technicians and clinicians to deliver remarkable care to patients.
Monitor reports on medical occurrences, patient safety and client experience and partners with stakeholders as needed to ensure swift resolution, improvements, and/or coaching as needed.
Work collaboratively with the BluePearl Support Team to develop solutions for escalated concerns and influences medical leaders to shape adoption and ensure effectiveness of resolutions.
Travel around 50% to ensure in-person leadership and mentoring in hospitals.
EDUCATION/EXPERIENCE
Bachelor's Degree and DVM (Doctor of Veterinary Medicine) required.
Completion of 1-year rotating internship required.
May be Emergency Clinician or board-certified Specialty Clinician.
7+ years of leadership experience required (previously overseeing multiple sites or revenues exceeding $25MM preferred.)
Why BluePearl?
Our passion is pets. We offer Trupanion pet insurance and discounts to our associates for pet treatments, procedures, and food.
We encourage you to grow with us. Our technicians are leveled by their skillset and move up in level as they gain more skills and experience. We are focused on developing our associates into leaders through talent development programs and leadership workshops. As a member of Mars Veterinary Health, our associates have endless opportunities to advance in his/her career.
In order to transform and lead the industry through innovative quality medicine and care, we understand the importance of continuous learning. We offer annual continuing education allowance, free continuing education sessions, our own BluePearl University for training, and our clinicians have access to over 2,000 medical journals.
We value your health and well-being as an associate by providing you with the following:
Health, dental, vision, and life insurance options.
Annual company store allowance.
Flexible work schedules.
Time to reset, rewind, and reflect through our paid time off, paid parental leave, and floating holiday plans.
A regional licensed social worker who can provide guidance, advice, and tips/tricks on how to maintain a healthy lifestyle while working in a fast-paced emergency and specialty care environment.
We promote a family-like culture in our hospitals. We are all in this together. We believe in working together to lead the industry by enriching lives through remarkable care for pets
BluePearl is committed to a diverse work environment in which all individuals are treated with respect and dignity. We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, creed, sex, age, disability, genetic information, marital status, citizenship status, sexual orientation or affectional preference, or gender identity or expression, protected veteran status, or any other characteristic protected by law. If you need assistance or an accommodation during the application process because of a disability, it is available upon request. The company is pleased to provide such assistance, and no applicant will be penalized as a result of such a request. We are an Equal Opportunity Employer and a Drug Free Workplace.
$154k-235k yearly est. Auto-Apply 6d ago
Medical Director
Medpace 4.5
Remote public health director job
We are seeking a Medical Director with clinical specialization (varying therapeutic areas including, but not limited to, Immunology/Allergy, Psychiatry, GI/Nephrology, Cardiology and more) to join our dynamic team. The Medical Director will have overall responsibility for providing medical, scientific, and strategic leadership for the successful planning, execution, and reporting of clinical trials. Additionally, this role acts as the Medpace internal medical expert and will serve as a medical resource for the review, presentation, and interpretation of results in the Clinical Study Report. The Medical Director will also be involved in the development of new clinical projects, including study design, protocol, and project plans as required.
All Medical Directors have hybrid WFH flexibility. This role also has the ability to be fully remote with the right experience.
Responsibilities
* Provide medical management and expertise for clinical trials;
* Contribute medical expertise to study reports, regulatory documents, and manuscripts;
* Manage safety issues in clinical trials and work closely with associates in evaluation and assessment of the trials;
* Participate in new business development through involvement in proposal and sponsor meetings as requested;
* Coordinate with other departments in all phases of the studies and trials including feasibility assessments, design processes, educational efforts, management of medical information, and reviewing and editing of medical documents;
* Follow specific research related protocol and lead others in strict adherence to the policies.
Qualifications
* Must have an M.D., with a therapeutic area specialization
* Must be eligible to obtain a medical license
* Board certification preferred
* Prior clinical trial research experience preferred
* Previous experience in pharmaceutical-related clinical research is preferred.
Travel: up to 20%
Medpace Overview
Medpace is a full-service clinical contract research organization (CRO). We provide Phase I-IV clinical development services to the biotechnology, pharmaceutical and medical device industries. Our mission is to accelerate the global development of safe and effective medical therapeutics through its scientific and disciplined approach. We leverage local regulatory and therapeutic expertise across all major areas including oncology, cardiology, metabolic disease, endocrinology, central nervous system, anti-viral and anti-infective. Headquartered in Cincinnati, Ohio, employing more than 5,000 people across 40+ countries.
Why Medpace?
People. Purpose. Passion. Make a Difference Tomorrow. Join Us Today.
The work we've done over the past 30+ years has positively impacted the lives of countless patients and families who face hundreds of diseases across all key therapeutic areas. The work we do today will improve the lives of people living with illness and disease in the future.
Cincinnati Perks
* Cincinnati Campus Overview
* Flexible work environment
* Competitive PTO packages, starting at 20+ days
* Competitive compensation and benefits package
* Company-sponsored employee appreciation events
* Employee health and wellness initiatives
* Community involvement with local nonprofit organizations
* Discounts on local sports games, fitness gyms and attractions
* Modern, ecofriendly campus with an on-site fitness center
* Structured career paths with opportunities for professional growth
* Discounted tuition for UC online programs
Awards
* Named a Top Workplace in 2024 by The Cincinnati Enquirer
* Recognized by Forbes as one of America's Most Successful Midsize Companies in 2021, 2022, 2023 and 2024
* Continually recognized with CRO Leadership Awards from Life Science Leader magazine based on expertise, quality, capabilities, reliability, and compatibility
What to Expect Next
A Medpace team member will review your qualifications and, if interested, you will be contacted with details for next steps.
$172k-264k yearly est. Auto-Apply 8d ago
Medical Director(Preferred Experience in Managed Care)
Caresource 4.9
Remote public health director job
The Medical Director is responsible for supporting staff by providing training, clinical consultation, and clinical case review for members.
Essential Functions:
Provide prior authorization medical reviews, consultation and clinical review services
Participate in peer-to-peer discussions
Provide provider education, training, data sharing, performance evaluations and orientation to the plan
Conduct clinical reviews for designated CareSource members as requested
Provide physician review for clinical appeals cases
Participate in the evaluation and investigations of cases suspected of fraud, abuse, and quality of care concerns
Participate in development of policies and procedures
Participates in quality improvement initiatives, case management activities and member safety activities (i.e. incident management
Provide cross-coverage for other Medical Directors and/or markets, as needed
Oversight and quality improvement activities associated with case management activities
Assist in the review of utilization data to identify variances in patterns, and provide feedback and education to MCP staff and providers as appropriate
Participate in the development, implementation and revision of the clinical care standards and practice guidelines ensuring compliance with nationally accepted quality standards
Participate in the development, implementation and revision of the Quality Improvement Plan and corporate level quality initiatives
Collaborate with market/product leaders to help define market strategy
Community collaborative participation
Support of regulatory and accreditation functions (eg. CMS, State, NCQA and URAC) and compliance for all programs
Perform any other job related instructions, as requested
Education and Experience:
Completion of an accredited Medical Degree program as a medical doctor (MD) or Doctor of Osteopathic (DO) medicine is required
Successful completion of a residency training program, preferably in primary care is required
Minimum of five (5) years of clinical practice experience is required
Managed care medical review/medical director experience is preferred
Bachelor's or Master's degree in Business Administration, Operational Excellence, Healthcare Administration or Medical Management is preferred
Competencies, Knowledge and Skills:
Basic Microsoft Word skills
Excellent communication skills, both written and oral
Ability to work well independently and within a team environment
Ability to create strong relationships with Providers and Members
High ethical standards
Attention to detail
Critical listening and systematic thinking skills
Ability to maintain confidentiality and act in the company's best interest
Ability to act with diplomacy and sensitivity to cultural diversity
Decision making/problem solving skills
Conflict resolution skills
Strong sense of mission and commitment of time, effort and resources to the betterment of the communities served
Licensure and Certification:
Current, unrestricted license to practice medicine in state of practice as necessary to meet regulatory requirements is required
Board Certification, preferably in primary care specialty is required
Re-certification, as required by specialty board, must be maintained (exceptions may be granted by Chief Medical Officer)
MCG Certification is required or must be obtained within six (6) months of hire
Working Conditions:
General office environment; may be required to sit or stand for extended periods of time
May be required to work evenings/weekends
May be required to travel to fulfill duties of position
Compensation Range:
$191,400.00 - $334,900.00
CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package.
Compensation Type (hourly/salary):
Salary
Organization Level Competencies
Fostering a Collaborative Workplace Culture
Cultivate Partnerships
Develop Self and Others
Drive Execution
Influence Others
Pursue Personal Excellence
Understand the Business
This is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.#LI-SW2
$191.4k-334.9k yearly Auto-Apply 58d ago
Medical Director
Lancesoft 4.5
Remote public health director job
Required licensure: TX, KY, FL, WA licenses are preferred
The Behavioral Health Physician will serve as an independent contractor providing physician-level utilization management (UM) services for behavioral health services. This role is non-clinical and limited exclusively to medical necessity determinations, peer-to-peer reviews, and appeals in accordance with applicable regulations, accreditation standards, and plan policies.
Scope of Services
The Contractor will perform UM activities including, but not limited to:
Initial Medical Necessity Reviews for behavioral health services requiring physician-level determination
Concurrent Reviews for continued authorization of services
Peer-to-Peer (P2P) Reviews with treating providers
Appeals Reviews, including first- and second-level determinations, as applicable
Issuance of adverse determinations when clinically indicated, ensuring compliance with federal and state regulations, parity requirements, and plan policies
Documentation of determinations in UM systems with clear clinical rationale and supporting criteria
Participation in quality improvement processes related to UM decisions, as requested
Exclusions / Non-Scope
This role does not include:
Direct patient care or treatment
Prescribing services
Care coordination or case management
Administrative leadership or supervisory responsibilities
Clinical Expertise & Requirements
MD or DO with board certification in Psychiatry (required)
Active, unrestricted medical license in applicable state(s) of review
Experience in behavioral health utilization management, preferably in managed care or health plan settings
Demonstrated knowledge of:
Medical necessity criteria (e.G., MCG, InterQual, or equivalent)
Federal and state behavioral health regulations
MHPAEA requirements
NCQA and CMS standards
Strong peer-to-peer communication skills
Work Expectations
Remote work environment
Flexible scheduling based on case volume and turnaround time requirements
Ability to meet required regulatory and contractual decision timelines
Maintain confidentiality and comply with HIPAA and data security standards
Reporting & Oversight
Operates independently while adhering to health plan UM policies, delegated authority parameters, and medical policy
Subject to audit, quality oversight, and performance monitoring consistent with UM regulatory requirements
$180k-291k yearly est. 37d ago
REMOTE - Medical Director, Health Plan
Martin's Point Health Care 3.8
Remote public health director job
Join Martin's Point Health Care - an innovative, not-for-profit health care organization offering care and coverage to the people of Maine and beyond. As a joined force of "people caring for people," Martin's Point employees are on a mission to transform our health care system while creating a healthier community. Martin's Point employees enjoy an organizational culture of trust and respect, where our values - taking care of ourselves and others, continuous learning, helping each other, and having fun - are brought to life every day. Join us and find out for yourself why Martin's Point has been certified as a "Great Place to Work" since 2015.
Position Summary
The Medical Director (MD) provides clinical leadership and direction to the utilization & care management functions of Martin's Point's Health Plans. The MD works collaboratively with other plan functions that interface with Medical Management such as Health Management, Compliance and Appeals, , Network Management, Member Services, benefits & claims management, and Compliance. In this role, there is the opportunity to assist in or drive short and long-range clinical programming, quality management, and external relationships. The Medical Director reports to the Vice President Health Plan Medical Director and works closely with the other Health Plan leaders.
Job Description
Key Outcomes:
Responsible and accountable to the Health Plan Medical Director for helping to manage health plan medical costs by assuring clinically appropriate health care delivery for health plan products and services utilizing Evidence-Based Guidelines to ensure the right service at the right time and place for each member
Performs medical necessity reviews of requests for health plan-covered services (benefits). Reviews disputes and appeals of said services for clinical appropriateness and in compliance with government program rules
Contributes to case reviews to ensure the quality and safety of care and services delivered to Martin's Point Health Plan members.
Assists in the construction of the annual Utilization Management, Care Management, and Disease Management Program Descriptions and works to ensure the programs meet accreditation and regulatory standards (e.g. NCQA, CMS, TRICARE)
Participates in medical policy review and policy development.
Works with Informatics, Network Management, and Medical Economics to create and maintain a system where Network providers are properly assessed in regard to cost management and develops a plan and schedule for communication and solutioning with outliers.
Develops an in-depth understanding of ACOs and contributes to their management and strategic deployment.
Provides support to Health Plan risk adjustment activities as needed.
Is conversant with Health Plan key performance metrics, in particular utilization and cost management goals, MLR , inpatient days/1000, SNF days/1000, and clinical quality improvement (QI) objectives, including HEDIS and how to drive improvement in these areas
Education/Experience:
Board certified physician with post-graduate experience in direct patient care required
Medical leadership in, or focused activity of, a Health Plan (preferred)
Knowledge of process improvement tools
Experience in Health Plan utilization management
Experience in Medicare Advantage and/or TriCare preferred
Required License(s) and/or Certification(s):
Active and unrestricted license to practice medicine in Maine or New Hampshire; or another U.S. state with eligibility to apply for and obtain additional state licensure.
Current, or ability to have some, active clinical work with patients
Skills/Knowledge/Competencies (Behaviors):
Deep knowledge and practical understanding of Health Care systems and Managed Care concepts
Knowledge and deep commitment to performance-based Health Plan systems
Good analytic skills with the ability to identify meaningful trends and targets for improvement
Excellent interpersonal skills and demonstrated ability to establish rapport and working relationships with providers, service vendors and internal staff
Willingness to explore innovative methods of providing medical management
Supports the culture and models the MPHC values
This position is not eligible for immigration sponsorship.
We are an equal opportunity/affirmative action employer.
Martin's Point complies with federal and state disability laws and makes reasonable accommodations for applicants and employees with disabilities. If a reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact *****************************
Do you have a question about careers at Martin's Point Health Care? Contact us at: *****************************
$250k-353k yearly est. Auto-Apply 14d ago
Medical Director (Utilization Management)
HJ Staffing 3.9
Remote public health director job
HJ Staffing is urgently seeking a Medical Director of Utilization Management to join a leading Medicare Advantage Health Plan. This physician leader will play a critical role in ensuring the clinical integrity of inpatient and post-acute care reviews, evaluating medical necessity to support optimal outcomes and regulatory compliance.
Location: 100% Remote
Schedule: Full-Time, Monday - Friday (Must work PST hours)
Job Description
Reporting to the Chief Medical Officer, the Medical Director focuses on Evaluating hospital admissions, continued stays, and post-acute services for Medicare Advantage members. You will guide timely care determinations using CMS regulations and evidence-based practices (MCG/InterQual) while collaborating with care management teams and external providers.
What You Will Do
Clinical Review: Conduct timely medical necessity determinations for inpatient admissions and post-acute settings (SNF, IRF, LTACH, and Home Health).
Criteria Application: Use evidence-based guidelines (MCG/InterQual) and CMS criteria to assess the appropriateness of acute care services.
Peer-to-Peer: Lead discussions with attending physicians to clarify clinical documentation and support appropriate levels of care.
Complex Case Management: Serve as the primary physician reviewer for escalated or complex UM cases requiring expert medical judgment.
Collaboration: Partner with utilization and care management teams to ensure consistent, cost-effective care and participate in UM committee meetings.
Compliance & Documentation: Ensure all decisions are documented according to NCQA and CMS requirements; support audit preparedness and delegated oversight.
Utilization Trends: Identify patterns in care and support interventions to reduce unnecessary admissions or extended stays.
What You Will Bring
Credentials: Licensed M.D. or D.O. in good standing in your state of residence.
Clinical Experience: Minimum of 5 years of clinical experience.
Managed Care Expertise: At least 3 years in a utilization management or medical leadership role within a managed care or health plan setting.
Specialized Knowledge: Strong experience in inpatient/post-acute case review and deep knowledge of Medicare Advantage regulations and CMS coverage criteria.
Technical Skills: Extensive experience with MCG guidelines and advanced proficiency in MS Office and medical management software.
Education (Preferred): MPH, MBA, or MHA; Certification by the American Board of Quality Assurance and Utilization Review Physicians (ABQAURP).
You Will Be Successful If:
You are an expert in using data to design and implement clinical programs and population health management.
You possess strong negotiation skills, particularly in physician-to-physician interactions.
You thrive in a matrix organization and can mentor staff while making independent, high-stakes decisions.
You have a meticulous eye for detail and can maintain a reasonable rate of speed in a fast-paced, high-volume environment.
You are committed to the highest standards of confidentiality and clinical documentation.
$167k-244k yearly est. Auto-Apply 6d ago
Medical Director
Arc Group 4.3
Remote public health director job
Job DescriptionMEDICAL DIRECTOR - REMOTE ARC Group has an immediate opportunity for a Medical Director! This position is 100% remote working eastern time zone business hours. This is a direct hire FTE position and a fantastic opportunity to join a well-respected organization and have a positive impact on the lives of millions of people.
At ARC Group, we are committed to fostering a diverse and inclusive workplace where everyone feels valued and respected. We believe that diverse perspectives lead to better innovation and problem-solving. As an organization, we embrace diversity in all its forms and encourage individuals from underrepresented groups to apply.
100% REMOTE!
Candidates must currently have PERMANENT US work authorization. Sorry, but we are not considering any candidates from outside companies for this position (no C2C, 3rd party / brokering).
SUMMARY STATEMENT
The Medicare Contractor Medical Director (CMD) provides medical leadership and decision making for an organization that serves as a Medicare Administrative Contractor (MAC). This role serves as a liaison between the Centers for Medicare and Medicaid Services (CMS) and stakeholders. CMDs play a vital role in developing Local Coverage Determinations (LCDs) and ensuring compliance with Medicare policies, reviewing medical claims, and promoting evidence-based healthcare.
ESSENTIAL DUTIES & RESPONSIBILITIES
Clinical Expertise and Consultation 30%
Provide leadership in clinical program outreach to the practitioner/provider/supplier/beneficiary community.
Provide direction and assistance to clinical staff in conducting provider education, as well as assist in the development of clinical guidelines as needed.
Keep clinical knowledge up to date and abreast of medical practice and technology changes.
Serve as a subject matter expert in medical and clinical areas relevant to the Medicare program.
Provide clinical consultation to internal teams (e.g., medical review staff, appeals teams) and external stakeholders.
Provide the clinical expertise, scientific literature analysis, claims data analytics to effectively focus medical polical policy and reviews on identified problem areas.
Collaboration and Leadership 30%
Collaborate with CMS and other Medicare Contractors (e.g., A/B or DME MACs and others) to develop and update medical policies and articles based on clinical evidence and regulatory requirements.
Work with multidisciplinary teams within the MAC to improve processes and ensure compliance with CMS directives.
Liaise with CMS staff, medical societies, and other stakeholders to align goals and address emerging issues.
Represent the MAC at CMS meetings and industry conferences.
Strengthen the quality improvement procedures with emphasis on decision consistency and clinical education of clinical staff through various mechanisms including but not limited to overseeing Inter-Reviewer Reliability (IRR) reviews.
Program Integrity 20%
Support program integrity initiatives, including identifying trends in inappropriate billing practices or noncompliance.
Ensure the proper application of Medicare regulations, national and local coverage determinations (NCDs and LCDs), and clinical guidelines.
Participate in all phases of LCD development by leading the Local Coverage Determination (LCD) process to include development, revision, retirement, education, and decision making.
Collaborate with investigative teams and law enforcement when required.
Medical Review (MR) and Appeals 10%
Oversee medical review activities to ensure appropriate and consistent decisions on claim determinations including pre- and post-payment determinations.
Provide leadership in developing and implementing MR Quality Assurance Programs.
Provide leadership in effectively focusing MR and developing internal MR guidelines.
Review complex or high-level appeals and provide guidance on the application of Medicare policies.
Provide support to the claim appeal process including assistance in the development of position papers and participation in the administrative process when needed such as Administrative Law Judge (ALJ) hearings.
Provider Education and Communication 10%
Provide leadership in the provider community (including interacting with hospital/specialty associations).
Educate providers, individually or as a group, regarding identified problems or medical policy.
Maintain Professional and Organization Relationships
Performs other duties as the supervisor may, from time to time, deem necessary.
Travel within and outside the assignedjurisdictions, as needed. Expected to be no more than 3-4 weeks/year but could vary based on business needs.
REQUIRED QUALIFICATIONS
MD or DO degree from accredited Medical School
Minimum of three years clinical practice experience as an attending physician
Extensive knowledge of the Medicare program, particularly the coverage and payment rules
Work experience in the health insurance industry, a utilization review firm, or another health care claims processing organization in a role that involved developing coverage or medical necessity policies and guidelines.
Knowledge, skill, and experience to evaluate clinical evidence, and to develop evidence-based medical necessity standards within the Medicare fee-for-service benefit structure
Ability to develop strategies and processes to ensure evidence-based decision-making for policy in the Medicare population
Basic understanding of medical coding conventions
Ability to effectively communicate, collaborate with, and provide education on health care policy issues to both internal team members and external entities
Ability to work collaboratively with internal staff to evaluate aberrancies, determine appropriate billing, coding, pricing, and utilization of services
Proficiency with effective public speaking and ability educate providers
Ability to work collaboratively with clinical and non-clinical team members
Ability and desire to educate team members and external entities (i.e., CMS, providers, other federal agencies, law enforcement, etc.)
Computer literacy, including proficiency using word processing, spreadsheets, presentation, and virtual meeting applications
Ability to complete independent or computer-based training and education
Certifications, Licenses, Registration:
Current, active, valid, unrestricted license to practice medicine in at least one state or territory within the United States, never suspended or revoked in any state or territory of the United States
Eligible for licensure within jurisdiction of enterpriseoperations
Board Certified Doctor of Medicine or a Doctor of Osteopathy in a specialty recognized by the American Board of Medical Specialties for at least three years
PREFERRED QUALIFICATIONS
Experienced Physical Medicine and Rehabilitation (PM&R), Oncology, Radiology, Ophthalmology or Infectious Diseases professionals with five years of clinical practice
MBA, MHA, MS in Management, or formal accredited coursework in medical systems management
Demonstrated successful working experience in organized medicine group(s) (e.g., AMA, specialty society, state health department) as a committee chairperson or other leadership
Medical Director experience in Medicare-related or commercial healthcare organization
Coding and billing experience utilizing HCPCs, CPT, and ICD-10 codes
Experience using GRADE methodology for literature analysis and performing systematic reviews
Experience working with physician groups, beneficiary organizations, and/or congressional offices
Would you like to know more about our new opportunity? For immediate consideration, please send your resume directly to John Burke at ******************** or apply online while viewing all of our open positions at *******************
ARC Group is a Forbes-ranked a top 20 recruiting and executive search firm working with clients nationwide to recruit the highest quality technical resources. We have achieved this by understanding both our candidate's and client's needs and goals and serving both with integrity and a shared desire to succeed.
At ARC Group, we are committed to providing equal employment opportunities and fostering an inclusive work environment. We encourage applications from all qualified individuals regardless of race, ethnicity, religion, gender identity, sexual orientation, age, disability, or any other protected status. If you require accommodations during the recruitment process, please let us know.
Position is offered with no fee to candidate.
$144k-225k yearly est. Easy Apply 18d ago
Medical Director, Rheumatology / Dermatology Medical Strategy
Otsuka America Pharmaceutical Inc. 4.9
Public health director job in Columbus, OH
The Medical Director, Rheumatology and/or Dermatology Medical Strategy is a critical role responsible for shaping the strategic processes and planning for assets in early development (e.g., pre-Phase 3) within the Nephrology and Immunology portfolio. This position manages the unique challenge of establishing an emerging portfolio, incorporating newly acquired assets, which requires significant scientific and strategic agility and a strong ability to balance competing priorities. This position reports directly to the Senior Director, Immunology Lead, who in turn reports to the Executive Director, Nephrology & Immunology Lead.
****
**Key Responsibilities Include:**
**Medical Strategy & Narrative**
+ Provide key medical input into the initial development of the Target Reimbursable Product Profile as well as early development plans ensuring scientific consistency and alignment across R&D, Clinical, Global Medical Affairs, and Early Commercialization functions
+ Provide high-quality scientific/clinical input and review of early asset plans, ensuring content aligns with the overarching Medical Narrative
+ Serve as a primary scientific resource, providing guidance on the disease state and mechanism of action for the early Nephrology and Immunology portfolio helping to translate science into value for patients and stakeholders
+ Lead the Strategy and Tactical Planning Process, identifying critical data needs for the emerging portfolio
**Evidence Generation Process**
+ Oversee the Medical Evidence Generation Process, translating strategic data gaps into clear research priorities and providing expert input into the design and feasibility of clinical trials and data generation initiatives
+ Support the planning and execution of Medical Affairs evidence generation activities relevant to early assets
**External Stakeholder Engagement**
+ Identify and engage Medical experts to support collection, curation and communication of clinical Medical and methodological insights to inform understanding of unmet medical needs, emerging standard of care and development opportunities
+ Develop Key Intelligence Topics & Questions (KITs/KIQs) for relevant assets, serving as the blueprint for insight collection from Medical Experts
+ Lead the strategic planning, content development, and successful facilitation of consulting activities including Advisory Boards, ensuring objectives align with data gap analyses and asset/portfolio strategy
+ Lead scientific exchange with Medical Experts to gather insights and validate development hypotheses
+ Support the development of scientific publications, abstracts, and presentations related to early assets
**Cross-functional Integration & Planning**
+ Collaborate within the Nephrology & Immunology Medical Business Unit with the Nephrology & Immunology Medical Communications and Field Medical Affairs sub-teams
+ Partner with and serve as a scientific and clinical resource for cross-functional colleagues including Clinical Development, Global Integrated Evidence & Innovation, Regulatory and Global Marketing and Market Access
+ Support indication prioritization and portfolio planning for early assets
+ Consider technology and AI to support workflow improvement
**Qualifications**
**Education and Experience:**
+ Advanced scientific degree is required (PharmD, MD, PhD, or equivalent) with expertise in **Rheumatology and/or Dermatology**
+ Preference for previous experience in Clinical Development, Research, or early-stage Medical Affairs
+ Expertise in Rheumatology or Dermatology is strongly preferred
+ Experience supporting BD evaluations for potential acquisitions
+ Experience contributing to the integration and strategic planning for newly acquired or in-licensed assets
+ Proven experience managing Evidence Generation processes and executing scientific Advisory Boards
**Skills and Competencies:**
+ Motivated and solution-oriented with the ability to work collaboratively across the organization, particularly with R&D and Clinical teams
+ Strategic agility required to build and adapt scientific strategy for an emerging portfolio
+ Excellent communication and interpersonal skills, including experience presenting complex development strategies to large internal groups and engaging a limited number of highly specialized external experts
+ Full understanding of rules and regulations in pharma, with the ability to apply knowledge of guidelines and regulations to early-stage Medical Affairs activities
+ Ability to work in a fast-paced, dynamic environment, with a proactive and problem-solving mindset
+ Strong understanding of drug development processes, especially early-stage development
+ \#LI-PG1
**Competencies**
**Accountability for Results -** Stay focused on key strategic objectives, be accountable for high standards of performance, and take an active role in leading change.
**Strategic Thinking & Problem Solving -** Make decisions considering the long-term impact to customers, patients, employees, and the business.
**Patient & Customer Centricity -** Maintain an ongoing focus on the needs of our customers and/or key stakeholders.
**Impactful Communication -** Communicate with logic, clarity, and respect. Influence at all levels to achieve the best results for Otsuka.
**Respectful Collaboration -** Seek and value others' perspectives and strive for diverse partnerships to enhance work toward common goals.
**Empowered Development -** Play an active role in professional development as a business imperative.
Minimum $209,599.00 - Maximum $313,375.00, plus incentive opportunity: The range shown represents a typical pay range or starting pay for individuals who are hired in the role to perform in the United States. Other elements may be used to determine actual pay such as the candidate's job experience, specific skills, and comparison to internal incumbents currently in role. Typically, actual pay will be positioned within the established range, rather than at its minimum or maximum. This information is provided to applicants in accordance with states and local laws.
**Application Deadline** : This will be posted for a minimum of 5 business days.
**Company benefits:** Comprehensive medical, dental, vision, prescription drug coverage, company provided basic life, accidental death & dismemberment, short-term and long-term disability insurance, tuition reimbursement, student loan assistance, a generous 401(k) match, flexible time off, paid holidays, and paid leave programs as well as other company provided benefits.
Come discover more about Otsuka and our benefit offerings; ********************************************* .
**Disclaimer:**
This job description is intended to describe the general nature and level of the work being performed by the people assigned to this position. It is not intended to include every job duty and responsibility specific to the position. Otsuka reserves the right to amend and change responsibilities to meet business and organizational needs as necessary.
Otsuka is an equal opportunity employer. All qualified applicants are encouraged to apply and will be given consideration for employment without regard to race, color, sex, gender identity or gender expression, sexual orientation, age, disability, religion, national origin, veteran status, marital status, or any other legally protected characteristic.
If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation, if you are unable or limited in your ability to apply to this job opening as a result of your disability. You can request reasonable accommodations by contacting Accommodation Request (EEAccommodations@otsuka-us.com) .
**Statement Regarding Job Recruiting Fraud Scams**
At Otsuka we take security and protection of your personal information very seriously. Please be aware individuals may approach you and falsely present themselves as our employees or representatives. They may use this false pretense to try to gain access to your personal information or acquire money from you by offering fictitious employment opportunities purportedly on our behalf.
Please understand, Otsuka will **never** ask for financial information of any kind or for payment of money during the job application process. We do not require any financial, credit card or bank account information and/or any payment of any kind to be considered for employment. We will also not offer you money to buy equipment, software, or for any other purpose during the job application process. If you are being asked to pay or offered money for equipment fees or some other application processing fee, even if claimed you will be reimbursed, this is not Otsuka. These claims are fraudulent and you are strongly advised to exercise caution when you receive such an offer of employment.
Otsuka will also never ask you to download a third-party application in order to communicate about a legitimate job opportunity. Scammers may also send offers or claims from a fake email address or from Yahoo, Gmail, Hotmail, etc, and not from an official Otsuka email address. Please take extra caution while examining such an email address, as the scammers may misspell an official Otsuka email address and use a slightly modified version duplicating letters.
To ensure that you are communicating about a legitimate job opportunity at Otsuka, please only deal directly with Otsuka through its official Otsuka Career website ******************************************************* .
Otsuka will not be held liable or responsible for any claims, losses, damages or expenses resulting from job recruiting scams. If you suspect a position is fraudulent, please contact Otsuka's call center at: ************. If you believe you are the victim of fraud resulting from a job recruiting scam, please contact the FBI through the Internet Crime Complaint Center at: ******************* , or your local authorities.
Otsuka America Pharmaceutical Inc., Otsuka Pharmaceutical Development & Commercialization, Inc., and Otsuka Precision Health, Inc. ("Otsuka") does not accept unsolicited assistance from search firms for employment opportunities. All CVs/resumes submitted by search firms to any Otsuka employee directly or through Otsuka's application portal without a valid written search agreement in place for the position will be considered Otsuka's sole property. No fee will be paid if a candidate is hired by Otsuka as a result of an agency referral where no pre-existing agreement is in place. Where agency agreements are in place, introductions are position specific. Please, no phone calls or emails.
$209.6k yearly 35d ago
Medical Director Risk Management
Ohiohealth 4.3
Public health director job in Columbus, OH
**We are more than a health system. We are a belief system.** We believe wellness and sickness are both part of a lifelong partnership, and that everyone could use an expert guide. We work hard, care deeply and reach further to help people uncover their own power to be healthy. We inspire hope. We learn, grow, and achieve more - in our careers and in our communities.
** Summary:**
The MDRM works daily with the Risk Managers and the lawyers and staff in the OGC addressing concerns impacting OhioHealth's liability with respect to professional liability claims and incidents and the review and oversight of practitioner claim trends from the organization's claims/incidence database. In partnering with System Quality, this role also identifies primary areas of risk and works with Quality to help focus on the organizational impact of risk, whether patient safety, reputational, or financial. This position will include reviewing potential claims for reporting to the OGC. This role is accountable for providing medical advice and support to the Risk Managers and OGC. This person must also be able to effectively work with the outside malpractice defense counsel to provide general medical advice with respect to malpractice claims defense when requested. The person will also support the patient grievance process at GMC and RMH.
**Responsibilities And Duties:**
60%
The Medical Director, Risk Management ("MDRM) will provide expertise and advice to support the Risk Management function throughout OhioHealth. The primary job duties of this individual are as follows, and as assigned:
The MDRM will provide expert medical analysis of incidents, risk matters, and claims and may interact with patients and family regarding the same. The MDRM's general function is to be the primary medical expert/resource/advisor to the Risk Management department and the Office of the General Counsel ("OGC). This will include interaction with in-house lawyers and outside malpractice defense counsel on incidents and claims as requested.
The MDRM will regularly attend the Risk Management/OGC Reserves meetings and provide advice and input on standard of care in connection with claims against OhioHealth for medical malpractice.
The MDRM, in conjunction with the other OhioHealth Risk Managers, may from time to time cooperate and provide information and expertise to the Quality and Patient Safety and Peer Review staff and leadership to help manage risk and prevent patient care errors.
The MDRM will be the primary medical expert reviewer of incidents and potentially compensable events (PCEs) as part of the OGC/RM "Significantly Involved Provider (SIP) program and provide SIP analyses to the Risk Managers and OGC lawyers managing litigation.
40%
For Grant Medical Center (GMC) and Riverside Methodist Hospital (RMH), the MDRM will:
Support, through collaboration with Patient Experience/Customer Service, the patient grievance process. In that regard, the MDRM will assist in or provide case evaluations, disclosures, review patient concerns and safety events, and make periodic calls and visits to patients and families when a physician or administrative representative is needed. The MDRM will attend the grievance committee meetings at GMC and RMH and participate in related system activities as appropriate.
Support the campus VP of Clinical Affairs and collaborate with hospital leadership on matters affecting patient services.
Oversee the system patient rights hotline and perform medical record reviews for potential patient harm as needed.
**Minimum Qualifications:**
Doctor of Osteopathic Medicine, Medical DoctorOLP - Ohio Licensed Physician - Ohio Medical Board
**Additional Job Description:**
**SPECIALIZED KNOWLEDGE**
Experience in peer review, quality and safety.
**Work Shift:**
Day
**Scheduled Weekly Hours :**
40
**Department**
Legal
Join us!
... if your passion is to work in a caring environment
... if you believe that learning is a life-long process
... if you strive for excellence and want to be among the best in the healthcare industry
Equal Employment Opportunity
OhioHealth is an equal opportunity employer and fully supports and maintains compliance with all state, federal, and local regulations. OhioHealth does not discriminate against associates or applicants because of race, color, genetic information, religion, sex, sexual orientation, gender identity or expression, age, ancestry, national origin, veteran status, military status, pregnancy, disability, marital status, familial status, or other characteristics protected by law. Equal employment is extended to all person in all aspects of the associate-employer relationship including recruitment, hiring, training, promotion, transfer, compensation, discipline, reduction in staff, termination, assignment of benefits, and any other term or condition of employment
$231k-325k yearly est. 60d+ ago
Medical Director, Clinical Science
Biomarin Pharmaceutical 4.6
Remote public health director job
Who We Are BioMarin is a global biotechnology company that relentlessly pursues bold science to translate genetic discoveries into new medicines that advance the future of human health. Since our founding in 1997, we have applied our scientific expertise in understanding the underlying causes of genetic conditions to create transformative medicines, using a number of treatment modalities.
Using our unparalleled expertise in genetics and molecular biology, we develop medicines for patients with significant unmet medical need. We enlist the best of the best - people with the right technical expertise and a relentless drive to solve real problems - and create an environment that empowers our teams to pursue bold, innovative science. With this distinctive approach to drug discovery, we've produced a diverse pipeline of commercial, clinical and preclinical candidates that have well-understood biology and provide an opportunity to be first-to-market or offer a substantial benefit over existing therapeutic options.
About Worldwide Research and Development
From research and discovery to post-market clinical development, our WWRD engine involves all bench and clinical research and the associated groups that support those endeavors. Our teams work on developing first-in-class and best-in-class therapeutics that provide meaningful advances to patients who live with genetic diseases.
BioMarin Clinical Science (CLS) is responsible for overseeing clinical programs across various phases, from proof-of concept to Phase 3 and BLA/NDA/MAA filing. The Clinical Science team provides leadership for clinical strategy and oversight to ensure excellence in clinical trial conduct, data analysis and interpretation, publication preparation, and safety monitoring BioMarin Clinical Science (CLS) is responsible for overseeing clinical programs across various phases, from proof-of concept to Phase 3 and BLA/NDA/MAA filing. The Clinical Science team provides leadership for clinical strategy and oversight to ensure excellence in clinical trial conduct, data analysis and interpretation, publication preparation, and safety monitoring.
Summary Description: Fully remote role - US based candidates
The Medical Director has a key scientific and analytical leadership role in the development of CLS core deliverables across study planning, design and execution, results analysis and regulatory filings. Key focus areas include: acting as a study Medical Monitor and providing the scientific input into the creation and review of all CLS study deliverables and monitoring subject eligibility, study data and contributing critically to the scientific interpretation and integration of clinical study results.The Medical Director will also contribute to the scientific strategy and plan as outlined in the Clinical Development Plan (CDP). The Medical Director is also responsible for providing medical input into the creation and review of all CLS study deliverables to support clinical decision making, problem solving, and safety surveillance, as well as collaboration with external physician stakeholders. Key Responsibilities:
Scientific Leadership
Support the definition of the core clinical and scientific strategy that serves as the basis for the CDP and provide CLS expertise in the design and execution of clinical studies under the purview of the CDP
Participate (as assigned) in the development of CLS-assigned sections of regulatory filings and in drafting regulatory responses in collaboration with Medical Writing
Establish relationships with investigators and KOLs as appropriate in support of the CDP
Stay up to date with advances in literature in therapeutic/disease area including mechanism of action, diagnostic tests, treatment, drug development trends, and regulatory requirements
Develop therapy-specific publication plans and work with internal and external colleagues to prepare study results for timely publication
Attend and contribute to relevant scientific conferences, seminars or presentations
Clinical Study Planning and Monitoring
Act as the scientific subject matter expert, and primary contact, for assigned clinical study; take a proactive approach to identifying issues and mitigating risk
Initiate and provide the medical and scientific content and insight for development and review of: protocols, protocol amendments; ICFs; CRFs; statistical tables and listings including accurate AE (MedDRA) and concomitant medications (WHODrug) coding; audit reports; clinical study reports; inspection readiness activities, regulatory submissions and other key study deliverables
Provide clinical input to statistical analysis plan to ensure alignment with Regulatory and business interests
Facilitate the review and approval of all study related CLS deliverables and content
Act as study scientific subject matter expert and main point of contact for Principal Investigators (PIs) and sites to assess subject eligibility, provide scientific rational and manage ongoing protocol issues
Provide leadership to sites by developing or participating in training, answering investigator/site questions about the protocol
Respond to site and Health Authority questions about the protocol
Conduct periodic review of protocol deviations in collaboration with Clinical Operations Study Lead or designee (per protocol specific Protocol Deviation Plan)
Attend and present at Investigator Meetings, as needed
Conduct data review, assessment and interpretation of clinical data to ensure that the data are correct and presented with the appropriate interpretation including thorough review of SAEs and other important AEs (per the study specific Medical Monitoring Plan)
Review and analyze SAEs, safety and efficacy trends on an ongoing basis
Work closely with the Pharmacovigilance representatives providing medical input into safety reports including, SAE narratives and analysis of similar events, Development Safety Update Reports (DSURs) and Suspected Unexpected Serious Adverse Reactions (SUSARs) reports, Company Core Safety Information (CCSI), Investigator Brochure (IB), Risk Management Plans, Integrated Summaries of Safety and Efficacy, Clinical Study Reports and preparation of labels
Participate in and provide scientific advice, as appropriate, during key Database Lock (DBL) activities (final listing review, review of blinded tables, listings and figures (TLFs), etc.) and actively participate in all data snapshots taken (not limited to final DBL)
Collaborate with Biometrics to identify key issues, prepare content and facilitate discussions at study Data Review Board (internal) or Data Monitoring Committee (DMC)
Lead the selection of and interactions with independent Data Monitoring Committees (DMC)
The Medical Director will also act as the medical subject matter expert for review of clinical and safety data to ensure data are correct and presented with the appropriate medical interpretation and for discussing safety concerns with sites
Governance and Communication
Provide timely and high-quality functional deliverables and contributions to Study Execution Team (SET)
Act as primary point of contact between SET and BCLS to ensure appropriate dissemination of information and communication (including functional managers and other relevant individuals)
Provide agenda topics to be discussed during SET meetings
Act as the medical and scientific subject matter expert (SME) to the SET with the ability to make decisions and recommendations on behalf of BCLS
Proactively identify and communicate potential risks and mitigations relevant to the BCLS deliverables
Contribute to the development and maintenance of study- specific plans; manage the development of study-specific plans that are the responsibility of BCLS
Collaborate with BCLS Therapeutic Area Lead, CDTL and CSL on all study related decisions, as appropriate
Escalate issues affecting BCLS function deliverable quality, timelines, resources or budget, as appropriate
Competencies
The Medical Director is expected to exhibit mastery-level understanding of multiple technical competencies, including scientific knowledge, data analysis, and scientific writing. S/he should also have advanced-level competence in several areas, including strategic thinking and problem solving. The Medical Director should:
Identify scientific and medical knowledge gaps in therapeutic area and target populations to drive research and publication strategies
Assess the clinical and medical impact of clinical and external research findings and data on overall therapeutic area and clinical development strategies
Conduct comprehensive document evaluations including evaluation of statistical presentations, research methods, quality and completeness of content
Identify internal and external best practices, trends, developments or alternative approaches that can be leveraged for strategy development
Demonstrate ability to look beyond the obvious toward innovative approaches, avoiding biases and historical crutches
The Medical Director will also demonstrate mastery of relevant clinical and therapeutic area knowledge to support clinical decision making, problem solving, safety surveillance, and as well as collaboration with external physician stakeholders. Education and Experience:
MD, MD/PhD (or equivalent)
Advanced degree in life or health sciences (e.g. PhD/PharmD/RN)
5 or more years of relevant experience in Clinical Development, with experience in genetic diseases, specialty care, and/or rare diseases desired; Clinical experience preferred
Note: This description is not intended to be all-inclusive, or a limitation of the duties of the position. It is intended to describe the general nature of the job that may include other duties as assumed or assigned.
Equal Opportunity Employer/Veterans/Disabled
An Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status and will not be discriminated against on the basis of disability.
$174k-246k yearly est. Auto-Apply 60d+ ago
Per Diem Health Plan UM Medical Director
Brigham and Women's Hospital 4.6
Remote public health director job
Site: Mass General Brigham Incorporated Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham.
Job Summary
Mass General Brigham Health Plan UM Medical Director
Qualifications
Education: MD or DO required
Licenses and Credentials:
* Physician - Massachusetts active full license required
Experience:
* 5+ years of Health Plan UM experience
* at least 5 years of clinical practice experience
Knowledge, Skills and Abilities:
* Utilization Management experience
* Excellent written and oral communications skills
* Proficient in basic computer skills, use of EHR's, digital tools
* Multitasking abilities
* Adaptable to change due to business growth
Job Description:
* Handles utilization management initial determinations, appeals and grievances within the scope of their expertise as defined by Medicare, MassHealth, NCQA and the Division of Insurance and within the compliance requirements of key regulatory and accreditation entities
* Use CMS, state and internal medical necessity policies to guide MN determinations
* Complete peer to peer case discussions with requesting providers as assigned
* Refer to IRO/external review if specialist match or expertise is needed
* Interact, communicate and collaborate with network and community physicians, hospital leaders and other vendors regarding care and services for enrollees
* Monitors performance metrics to identify areas for continuous improvement and ensure compliance
* Establishes and maintains positive relationships with colleagues and customers and gains their trust and respect
* Ensure diversity, equity and inclusion are integrated as a guiding principle
Other duties as assigned with or without accommodation
Additional Job Details (if applicable)
* Primarily remote position
* M-F 830-5pm EST
* Ensures that all assigned work is completed within regulatory timelines
* Checks and addresses assigned work queues, email, Teams messages during assigned work hours
Remote Type
Remote
Work Location
399 Revolution Drive
Scheduled Weekly Hours
0
Employee Type
Regular
Work Shift
Day (United States of America)
EEO Statement:
Balance Sheet Cost Centers is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veteran's Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants who require accommodation in the job application process may contact Human Resources at **************.
Mass General Brigham Competency Framework
At Mass General Brigham, our competency framework defines what effective leadership "looks like" by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.
$179k-266k yearly est. Auto-Apply 12d ago
Medical Director, Rheumatology | Part Time | Remote | NantHealth
Nanthealth 4.5
Remote public health director job
NantHealth is adding a part time Medical Director, Rheumatology to the Eviti team. The Rheumatologist - Medical Director is a key clinical leader responsible for supporting and further developing the NantHealth, Inc. Eviti Solution as it relates to autoimmune and inflammatory diseases, including oversight of utilization management and clinical policy for high-cost immunomodulatory and biologic therapies. The role serves in a matrix leadership capacity across clinical operations, content development, and client engagement.
The role works closely with the NantHealth Medical Office professional staff of specialty nurse practitioners and physician reviewers who conduct medical record and treatment plan review, systems input, and reporting to payer clients through the eviti | Connect platform. While this position does not include direct managerial oversight of staff, it provides clinical leadership, guidance, and subject-matter expertise across teams.
The Eviti Solution Medical Office functions to ensure that treatments for autoimmune and inflammatory diseases-including biologic agents, targeted small molecules, immunosuppressive therapies, off-label use, and step-therapy sequencing-are consistent with evidence-based medicine, nationally recognized best practices, and payer-defined standards of medical necessity, with the goal of supporting delivery of high-quality, appropriate care to patients.
This is a national-impact, part-time role, with the Rheumatologist - Medical Director serving as a key clinical interface between payer clients, treating physicians, and NantHealth clinical and content teams, supporting day-to-day treatment plan review activities through clinical influence and expertise.
The Rheumatologist - Medical Director will serve as a primary clinical consultant for the eviti | Connect product, conducting peer-to-peer discussions with practicing rheumatologists and other specialty providers regarding patient treatment plans. The Director will be located within the continental United States or its territories when conducting peer-to-peer consultations.
In addition to autoimmune drug utilization management, this role will have defined responsibilities in the development and oversight of clinical policies related to autoimmune diagnostics and monitoring, including appropriate use of advanced imaging, laboratory testing, and immunologic/genetic assays where relevant to rheumatologic care.
Responsibilities include collaboration with Clinical Content, Informatics, and specialty work groups to support the development, refinement, and ongoing maintenance of clinical guidelines for autoimmune conditions such as rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, lupus, vasculitis, and other systemic inflammatory diseases. The Director will participate in multidisciplinary clinical committees and work groups, ensure timely updates to guidance as standards of care evolve, and help align diagnostic and therapeutic decision-making with disease activity, prior treatment response, and line of therapy.
This is a remote position, requiring availability for up to 5 hours per week.
Responsibilities include, but are not limited to:
Provide clinical leadership and oversight of autoimmune disorder policies, including imaging and genetics/genomics, within the NantHealth clinical library for designated clients and payer partners, assuming greater ownership as familiarity with NantHealth operations, content, and platforms grows.
Serve as a medical liaison between the Chief Medical Officer, Clinical Content, Product, and Client teams, ensuring alignment of clinical strategy, policy development, and operational execution for autoimmune care.
Demonstrate thought leadership and deep expertise in autoimmune disorders, collaborating with client clinical teams and participating in multidisciplinary work groups and committees focused on rheumatology, imaging, and genomics.
Work closely with client leadership, NantHealth Content, and Product Management to identify new clinical opportunities, enhancements, and decision-support capabilities across systemic therapy, imaging, and precision medicine for autoimmune conditions.
Provide clinical oversight and guidance for treatment plan reviews performed by certified nurses and nurse practitioners, ensuring consistency with evidence-based care or appropriate, well-documented medical exceptions.
Serve as a primary clinical consultant, leading peer-to-peer discussions with treating physicians in a professional, collaborative, and clinically credible manner.
Support the development and refinement of internal processes, quality metrics, and reporting standards to ensure consistent, high-quality, and timely service delivery within approved operational frameworks.
Collaborate with Informatics and Clinical Content teams to ensure that autoimmune disorder, imaging, and genomics content remains current, accurate, and reflective of evolving standards of care.
Participate in quality assurance, performance improvement, and internal educational initiatives, and provide ongoing education to clinical staff on advances in autoimmune disease management, imaging, and precision medicine.
Maintain up-to-date knowledge of autoimmune disorder standards of care, emerging therapies, imaging modalities, and genomics trends, and apply this knowledge to clinical policy and decision-support development.
Contribute to the clinical software development lifecycle, including requirements definition, design input, testing, implementation, and ongoing optimization of NantHealth applications.
Through high-quality clinical leadership and client service, help enhance NantHealth's visibility, credibility, and value proposition in the autoimmune care marketplace while mentoring colleagues and fostering a culture of collaboration and continuous learning
Education & Experience Requirements:
Possess a Current Active Unrestricted Physician License in the United States or its territories
Medical or scientific degree required (M.D. or D.O.).
Board certification in Rheumatology and/or Clinical Immunology required.
Minimum of 5 years of post-training clinical experience in rheumatology, with demonstrated expertise in managing complex autoimmune disorders and familiarity with evolving standards of care.
Proven clinical leadership experience, with a record of scholarly activity, publications, or involvement in guideline development preferred.
Required Knowledge, Skills, and Abilities:
Strong understanding of rheumatology practice and the healthcare insurance landscape, including medical necessity, utilization management, and payer policy considerations for autoimmune conditions.
Excellent organizational skills with strong attention to detail and the ability to manage multiple priorities effectively.
Outstanding interpersonal and collaborative skills, with the ability to engage effectively with physicians, clinical staff, medical management, and cross-functional teams.
High level of computer proficiency, including Microsoft Word, Excel (data creation and analysis), and PowerPoint; comfort working within clinical decision-support platforms.
Familiarity with relational database concepts and clinical data systems preferred but not required.
Strong numerical aptitude and understanding of basic statistical concepts, with the ability to interpret and apply data to clinical decision-making.
Excellent oral and written communication skills, with well-developed analytical and problem-solving abilities.
Decisive, proactive, and adaptable, with a hands-on mindset and a willingness to engage directly in problem resolution.
Ability to thrive in a fast-paced, rapidly evolving environment, balancing strategic thinking with practical execution.
Demonstrated ability to build and maintain professional relationships across industry, physician networks, academia, and governmental or regulatory entities.
Highly motivated, energetic, and passionate about improving the quality, value, and integrity of autoimmune care.
Unwavering commitment to ethical conduct, scientific rigor, and professional integrity.
This is a part time, hourly position, budgeted at $175 / hour.