System Medical Director- Advanced Heart Failure
Atlanta, GA jobs
Piedmont Heart Institute System Wide Medical Director Advanced Heart Failure, Transplant and Mechanical Circulatory Support Reports to: Chief of Piedmont Heart Institute and Cardiovascular Services Piedmont Heart Institute (PHI) seeks a dynamic and accomplished Medical Director to lead our innovative team in delivering exceptional care to patients with heart failure, including heart transplantation and MCS across the system. This position offers a unique opportunity to shape a comprehensive program dedicated to improving patient outcomes and advancing clinical research. The ideal candidate will possess a robust background in heart failure management, a passion for collaboration, and a commitment to providing high-quality, patient-centered care within a multidisciplinary setting. Join us in our mission to transform the lives of patients facing the challenges of heart disease.
HIGHLIGHTS OF ROLE:
Piedmont Atlanta is recognized as the #1 LVAD implanting center and the 4th largest Heart Transplant center by volume in the US in 2024.
The facility has a highly skilled and experienced team specializing in heart failure support and services.
Piedmont Heart is a nationally acclaimed leader in extracorporeal membrane oxygenation (ECMO)and advanced MCS options. It features a top-tier imaging program (MRI) and exceptional Cath Lab support for complex coronary and valvular interventions.
Piedmont Atlanta hospital represents one of nation's highest patient complexity programs according to the national case mix index
With more than 25 hospitals reaching greater than 80% of the state's population, the PHI represents Georgia's largest advanced heart failure program.
PHI is internationally recognized as a leading center of innovation and research
QUALIFICATIONS REQUIRED OF MEDICAL DIRECTOR:
Experience delivering a comprehensive approach to Advanced Heart Failure, Transplant and MCS.
Board-certified in Advanced Heart Failure Cardiology
Commitment to maintaining high standards of care across a large healthcare system
Dedication to innovation and research
Essential Job Duties & Expectations
The Medical Director's specific responsibilities shall include, but not be limited to, the following:
System Heart Failure Practice Development:
Lead the System Heart Failure Practice by developing and implementing comprehensive care protocols for heart failure patients across the cardiology team.
Monitor and assess the success of these protocols through key performance metrics.
Provide recommendations to PHI Leadership and Hospital Administration in developing, managing, and budgeting the Advanced Heart Failure Program.
Perform other duties relating to the Program as requested by PHI and Hospital Administration.
Team Development and Interoperability:
Foster the growth of the Advanced Heart Failure Cardiology team through training and mentoring initiatives.
Promote collegiality among the AHF Cardiology and Cardiac Surgery Team to enhance interoperability, referrals, and sub-specialization.
Encourage open communication and feedback regarding patient selection and treatment planning in key multidisciplinary meetings.
Heart Failure Center of Excellence:
Co-Chair the Heart Failure Center of Excellence activities with the Surgical Director.
Effectively communicate essential program elements to the Center of Excellence (COE) participants.
Participate as a member of the PHI system-wide Leadership Council
Selection Committee Oversight:
Co-Chair weekly Heart Transplant/LVAD selection committee meetings alongside the Surgical Director.
Develop, update, and maintain selection criteria for Heart Transplant/LVAD candidates in collaboration with the Surgical Director
Facilitate consensus within the Selection Committee and actively engage HF cardiologists.
Quality Improvement Leadership:
Co-Chair the Heart Transplant and LVAD Quality Assurance and Performance Improvement (QAPI) committees with the Surgical Director.
Collaborate with the Surgical Director to develop, update, and maintain quality improvement metrics.
Lead initiatives to create and implement quality improvement programs to enhance relevant metrics.
Monitor, assess, and report on the progress of key metrics that reflect the success of clinical protocols.
Participate in Quality, Safety, Service (QSS), and Transplant Clinical Committee meetings.
Outreach Activities:
Collaborate with the Director of Heart Failure Outreach to develop and standardize HF therapies within and outside the Piedmont Healthcare System.
Monitor, assess, and report on the progress of key metrics that reflect the success of outreach activities and standardized HF care.
Establish and Cultivate National Presence
Develop strategies to enhance Piedmont Heart's recognition as a leading institution in advanced heart failure, transplant, and MCS.
Participate in national conferences, symposiums, and workshops to showcase clinical innovations, research findings, and successful outcomes.
Foster collaborations with key opinion leaders and institutions in the field to share best practices and drive advancements in patient care.
Engage in public speaking and educational initiatives to promote awareness of Piedmont Heart's contributions and expertise in advanced heart failure and MCS.
Leverage media and online platforms to disseminate knowledge, share success stories, and connect with the medical community.
Promote research and innovation within the heart failure program; set expectations for successful trial participation and conduct
Opportunity Highlights:
Competitive Salary with Guarantee
Sign-on Bonus
Comprehensive Benefits, to include 401k match and annual CME allowance
Epic EMR
Physician Governance opportunities
Quality, Service, and Reputation
Piedmont Heart combines a Level I Cardiovascular Center, with a multidisciplinary team of nurses, healthcare professionals and physicians, providing quality, compassionate care for patients with cardiac, thoracic and vascular conditions, with 180+ cardiovascular physicians and surgeons providing care at over 30 cardiology offices across the state of Georgia.
Comprised of 25 hospitals, more than 2,500 physicians, and over 700 physician and specialist offices across greater Atlanta and North Georgia, Piedmont Healthcare is a fast-growing, recognized leader in delivering expert care. Metro Atlanta's vibrant economy fuels a wealth of global communities and diverse cultural experiences, while the state of Georgia offers coastline beaches and mountain views. Live and work with the best at Piedmont in the big and small towns of the Peach State.
To be considered for this opportunity email *************************
“Applicants must be authorized to work for any employer in the US. We are able to sponsor H-1B visa waivers. We are unable to sponsor or take over sponsorship of J-1 employment visas at this time.”
Medical Director, Clinical Development - Blue Earth Diagnostics
Needham, MA jobs
Blue Earth Diagnostics is an established molecular imaging company focused on providing innovative, well-differentiated diagnostics solutions, informing patient management, and driving future therapies in cancer. Formed in 2014, Blue Earth Diagnostics' success is driven by our management expertise and agility, supported by our demonstrated track record of rapid development and commercialization of PET radiopharmaceuticals. Blue Earth Diagnostics' clinical focus is exclusively in cancer. Blue Earth Diagnostics is a subsidiary of Bracco Imaging S.p.A., a global leader in diagnostic imaging.Blue Earth Diagnostics is an established molecular imaging company focused on providing innovative, well-differentiated diagnostics solutions, informing patient management, and driving future therapies in cancer. Formed in 2014, Blue Earth Diagnostics' success is driven by our management expertise and agility, supported by our demonstrated track record of rapid development and commercialization of PET radiopharmaceuticals. Blue Earth Diagnostics' clinical focus is exclusively in cancer. Blue Earth Diagnostics is a subsidiary of Bracco Imaging S.p.A., a global leader in diagnostic imaging.
-
Job purpose
Reporting to the CMO, the Medical Director - Clinical Development will provide medical expertise and strategic leadership to product development programs across the Bracco Molecular Imaging (MI) platform. Responsibilities will include providing medical and scientific leadership and input to product development strategies, product profile development, competitive positioning, and pipeline asset lifecycle. With relevant program/project teams, the Medical Director will realize strategic goals by developing and executing Blue Earth sponsored clinical trials across multiple jurisdictions to GCP standards, engaging with thought leaders and stakeholders, contribution to upholding and improvement of policies and processes and supporting cross-functional teams as required. You will collaborate with cross functional teams including medical affairs, regulatory, imaging, pharmacovigilance, non-clinical, clinical operations, biostatistics, editorial and commercial to achieve company goals.
This is a remote position with a preference for candidates based in the Eastern or Central time zones.
Main Responsibilities, Activities, Duties and Tasks
Provide medical leadership within cross-functional Program Management Teams and projects related to clinical development.
Provide medical expertise to BED/Bracco MI clinical development programs and strategy including Phase I to successful product approval, and lifecycle management. Activities include:
Developing the product development strategy for pipeline assets with cross-functional partners
Serving as the primary medical representative in regulatory interactions related to product development
Developing clinical protocols, case report forms and clinical study reports for company sponsored programs, as well as medical review of other study-related documents (e.g. imaging charter, statistical analysis plan).
Acting as medical monitor for company sponsored clinical studies where appropriate.
Supporting the identification and recruitment of potential investigators for participation in Phase I-IV trials, and management of investigator relationships
Tracking medical safety for clinical trials and providing medical support for pharmacovigilance activities, including individual case report assessment.
Input and review of product investigator brochures and aggregate reports (e.g. development safety update reports)
Verifying scientific accuracy of safety and efficacy summaries for regulatory/commercial purposes and assisting with the clinical sections of regulatory dossiers
Medical and scientific oversight for Advisory Boards and Conference participation supporting clinical development activities.
Providing key medical input into publications and acting as a company medical voice within publication steering committees and managing author relationships
Providing strategic input and medical leadership in developing business cases for lifecycle opportunities with cross-functional partners within product development teams, especially medical affairs and commercial
Communicating medical and product development strategy with key internal and external stakeholders.
Responsibility for planned project activities, agreed upon and executed according to the milestones and the overall clinical development plan (including pre- and post-marketing activities)
Interpreting clinical study data and clearly communicating results to internal and external stakeholders
Medical input and direction to development of image acquisition and interpretation materials for pipeline assets.
Work collaboratively with the New Assets Evaluation team in co-development of clinical development plans for potential new assets, as required.
Work collaboratively with the Investigator Initiated Trials (IIT) team to define the IIT strategy and review proposals for pipeline assets
Contribute to appropriate SOP and policy development related to product development
Perform other duties and activities as assigned, including line management and acting as an internal imaging SME to provide ad-hoc support to medical affairs/commercial teams, in accordance with the needs of the business.
Other duties as determined by business needs
Education/Qualifications
Medical Degree required
Professional Experience, Knowledge, & Technical Skills
Clinical care and research experience in the therapeutic areas in which BED has products/developmental assets, preferred.
Minimum of five (5) years post Medical Degree experience, preferably with training and/or work experience in radiology or nuclear medicine, of which at least:
Three (3) years are within the Pharmaceutical or Biotech Industry working in Clinical Development
Understanding of the clinical trials and FDA approval processes, preferably with experience of FDA interactions.
Experience in Real World Evidence / Observational research preferred
Knowledge and understanding of US regulatory rules landscape (pertinent FDA Guidance for Industry).
Strong business and product marketing acumen, vision and perspective.
An ability to lead teams with or without management authority, empowering others while ensuring the quality of deliverables.
Ability to comprehend and combine complex sets of data, spanning multiple projects and products/agents.
Ability to handle multiple demands in a fast-paced environment and to interact within the context of multidisciplinary teams.
Ability to work independently to manage the activities of the function and to be accountable for these activities. Able to effectively plan in the medium to long term.
Able to proactively identify issues and problems, describe and assess risk and chances of product development success, and offer solutions and recommendations on product development issues. Able to make decisions under conditions of uncertainty.
If required, able to manage, develop and recruit high quality personnel to form, develop and maintain highly effective teams.
Ability to travel, domestic and international, estimated at approximately 30%, via airplane, train and/or motor vehicle will be required.
Qualified candidate must be legally authorized to be employed in the United States.
Annual Salary: $275,000.00-$325,000.00
Why Blue Earth Diagnostics?
We are seeking motivated individuals with drive and determination to succeed in an innovative and respectful team environment. Our employees are empowered to achieve great things and thrive in our exceptionally co-operative culture. As a young and dynamic company experiencing rapid growth, Blue Earth Diagnostics prides itself on providing a clear focus and incentives to achieve our business-critical objectives. We aim to have fun and celebrate each milestone along the way.
If you are seeking a job where you have a clear impact on business success, are working with talented and collaborative colleagues daily, and are doing something great for human healthcare, then this job is for you.
Blue Earth Diagnostics offers a highly competitive salary for high-caliber candidates. We also offer a comprehensive benefits package including a complete healthcare plan, 401k with matching, work/life harmony, and generous paid holidays.
Blue Earth Diagnostics is an equal opportunity employer. All qualified applicants will receive consideration for employment without discrimination on grounds of disability, age, race, color, religion, sex, national origin or any other characteristic protected by law.
Auto-ApplyMgr II Grievance/Appeals-Medical Coding
Atlanta, GA jobs
This role requires associates to be in-office 3 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of remote work, promoting a dynamic and adaptable workplace. Alternate locations may be considered.
Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.
This position is not eligible for employment based sponsorship.
Responsible for management oversight of grievances and appeals departmental units to investigate, resolve, and respond to grievances and appeals, manages inventory and production levels, and operational and plan risk, ensures quality, and regulatory compliance.
PRIMARY DUTIES:
* Leads team of coders in supporting appeals in regulated audits.
* Serves as a resource for complex issues and interpretation of claims, provider contracts and data, eligibility, member contracts, benefits, clinical decisions, pharmacy on pre-service and post service appeals and grievances related to non-clinical and clinical services, quality of service and quality of care issues including executive and regulatory grievances.
* Oversees and implements new subsystems, procedures, techniques and supports digital automation objectives.
* Analyzes and develops strategies by achieving performance thresholds within budgetary guidelines.
* Monitors trends and analyzes grievance and appeals data to identify and recommend plan and policy changes and to ensure state and federal regulatory compliance and resolution within the regulatory timeframes.
* Ensures programs support overall QI program and meet regulatory compliance/accreditation and the company standards.
* Hires, trains, coaches, counsels, and evaluates performance of direct reports.
Minimum Requirements:
Bachelor's degree and a minimum of 5+ years grievance & appeals experience and a minimum of 3 years of management experience in the healthcare industry; or any combination of education and experience which would provide an equivalent background.
Preferred Skills, Capabilities and Experience:
* Certified Professional Coder-AAPC
Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Who We Are
Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
How We Work
At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ******************************************** for assistance.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
Auto-ApplyBehavioral Health Medical Director-Psychiatrist Appeals
Atlanta, GA jobs
Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations could be considered.
Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.
Work schedule: Monday - Friday. Half day Saturday rotation, once a month.
The Behavioral Health Medical Director-Psychiatrist Appeals is responsible for the administration of behavioral health medical services, to ensure the appropriate and most cost-effective medical care is received. May be responsible for developing and implementing programs to improve quality, cost, and outcomes. May provide clinical consultation and serve as clinical/strategic advisor to enhance clinical operations. May identify cost of care opportunities.
How you will make an impact:
* Supports clinicians to ensure timely and consistent responses to members and providers.
* Provides guidance for clinical operational aspects of a program.
* Conduct peer-to-peer clinical appeal case reviews with attending physicians or other ordering providers to discuss review determinations.
* Serves as a resource and consultant to other areas of the company.
* May be required to represent the company to external entities and/or serve on internal and/or external committees. May chair company committees.
* Interprets medical policies and clinical guidelines. May develop and propose new medical policies based on changes in healthcare.
* Leads, develops, directs, and implements clinical and non-clinical activities that impact health care quality cost and outcomes.
* Identifies and develops opportunities for innovation to increase effectiveness and quality.
* Provides oversight, direction, and guidance to Medical Director Associates.
* Works independently with oversight from immediate manager.
* May be responsible for an entire clinical program and/or independently performs clinical reviews.
* Typically has program management responsibilities including clinical policy development, improvement of quality, cost, and outcomes, program development/implementation, and overseeing clinical/non-clinical activities.
Minimum Qualifications:
* Requires MD or DO and Board certification approved by one of the following certifying boards is required, where applicable to duties being performed, American Board of Medical Specialties (ABMS) or American Osteopathic Association (AOA).
* Must possess an active unrestricted medical license to practice medicine or a health profession.
* Unless expressly allowed by state or federal law, or regulation, must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US military base, vessel or any embassy located in or outside of the US.
* Minimum of 10 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
* For Health Solutions and Carelon organizations (including Behavioral Health) only, minimum of 5 years of experience providing health care is required.
* Additional experience may be required by State contracts or regulations if the Medical Director is filing a role required by a State agency.
Preferred Skills, Capabilities and Experiences:
* Child and Adolescent experience strongly preferred.
* Utilization Management experience.
* Applied Behavior Analysis (ABA) experience.
For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $250,236 to $428,976.
Locations: California; Colorado; District of Columbia (Washington, DC), Illinois, New Jersey; Maryland, Minnesota, Nevada; New York.
In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.
* The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law.
Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Who We Are
Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
How We Work
At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ******************************************** for assistance.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
Auto-ApplyNational Accounts Medical Director
Woburn, MA jobs
Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. Alternate locations may be considered.
The National Accounts Medical Director is responsible for serving as the Operational Medical Director for our care management models for our National Account clients. The medical director will be responsible for supporting the clinical vision and implementation to deliver an improvement in the health of the people we serve. The medical director supports product strategy/design through medical management that impact health care quality, cost, and outcomes, and improving access to the health improvement tools offered to clients/ members.
The medical director provides clinical expertise in all aspects of utilization review and case management. Provides input on the clinical relevance to account reporting regarding use of medical services by members. Involved in identifying and managing medical utilization trends, emerging trends and market changes that impact the client and members. Responsible for proactively identifying and solutioning with account management, Sales RVP Medical Directors.
How you will make an impact:
* Day to day clinical responsibilities means that the medical director is directly involved in Utilization Management and Case Management.
* Daily case reviews for both utilization and case management issues. (80/20 split)
* Consistent adoption and implementation of all medical policies used for operational reviews.
* Leading multidisciplinary rounds for case management /complex clinical management.
* Peer-to-peer outreach for both utilization reviews and also for case management consultation with treating providers.
* Clinical report reviews, trend management, benefit design consultation, and supporting overall clinical performance guarantee success.
* The medical director will be responsible for supporting all state specific requirements that apply for each state where there is our business.
Minimum Requirements:
* Requires MD or DO and Board certification approved by one of the following certifying boards is required, where applicable to duties being performed, American Board of Medical Specialties (ABMS) or American Osteopathic Association (AOA).
* Must possess an active unrestricted medical license to practice medicine or a health profession.
* Unless expressly allowed by state or federal law, or regulation, must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US military base, vessel or any embassy located in or outside of the US.
* Minimum of 10 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
* For Health Solutions and Carelon organizations (including behavioral health) only, minimum of 5 years of experience providing health care is required. Additional experience may be required by State contracts or regulations if the Medical Director is filing a role required by a State agency.
Preferred Qualifications:
* Indiana MD license or compact state multi-licensure is preferred but not exclusive.
* Board certification preferably in a Primary Health Specialty, Family or Internal medicine or Surgery (surgical specialty).
* Knowledge and experience with population or segment health management is a plus.
* Knowledge of the health insurance industry and the National Accounts segment is preferred.
For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $ 250,236 to $411,102
Locations: Illinois, DC, Nevada.
In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.
* The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law.
Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Who We Are
Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
How We Work
At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ******************************************** for assistance.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
Auto-ApplyMedical Director - Medical Policy
Woburn, MA jobs
Medical Director- Medical Policy Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. Alternate locations may be considered.
The Medical Director- Medical Policy is responsible for the administration of medical services for company health plans and helps ensure clinical integrity of broad and significant clinical programs, including the overall medical policies of the enterprise.
How you will make an impact:
* Responsible for active engagement in and development of medical policy across Elevance Health.
* Additional responsibilities may include oversight of preventive health service recommendations as well as credentialing policies.
* This position will also be active in engagement with external specialty societies and other external facing medical professional activities for the company.
* Interprets existing policies and develops new policies based on changes in the healthcare or medical arena.
* Leads, develops, directs and implements clinical and non-clinical activities that impact health care quality cost and outcomes.
* Supports the Medical Policy staff ensuring timely and consistent responses to members and providers.
* Supports coordination with external entities that develop clinical utilization management guidelines used by Company Plans (e.g., MCG Care guidelines, Carelon Medical Benefits Management guidelines and CarelonRx)
* Identifies and develops opportunities for innovation to increase effectiveness and quality.
* Serves as a resource and consultant to other areas of the company.
* May chair or serve on company committees including chair of the National Credentialing Committee.
Minimum Requirements:
* Requires MD or DO and Board certification approved by one of the following certifying boards is required, where applicable to duties being performed, American Board of Medical Specialties (ABMS) or American Osteopathic Association (AOA).
* Must possess an active unrestricted medical license to practice medicine or a health profession.
* Unless expressly allowed by state or federal law, or regulation, must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US military base, vessel or any embassy located in or outside of the US.
* Minimum of 10 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
* For Health Solutions and Carelon organizations (including behavioral health) only, minimum of 5 years of experience providing health care is required. Additional experience may be required by State contracts or regulations if the Medical Director is filing a role required by a State agency.
Preferred Qualifications:
* Extensive managed care or Medicare knowledge.
* MPH or MS in Epidemiology preferred, or equivalent experience and knowledge in evidence-based medicine and clinical epidemiology.
* Proficiency in writing preferred.
For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $262,152 to $393,228.
Locations: Illinois
In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.
* The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law.
Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Who We Are
Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
How We Work
At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ******************************************** for assistance.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
Auto-ApplyMedical Director - Cardiology
Atlanta, GA jobs
Clinical Operations Medical Director Carelon MBM Virtual: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development.
The Medical Director, Cardiology is responsible for supporting the medical management staff ensuring timely and consistent medical decisions to members and providers. In this role, you will participate in pre-authorization and quality improvement solutions for both specialized cardiology and vascular surgery. This includes but is not limited to cardiac procedures such as coronary angiography, percutaneous coronary interventions, implanted cardiac devices, electrophysiology procedures and arterial/venous endovascular interventions.
How you will make an impact:
* Ensures timely completion of clinical case reviews for their board certified specialty.
* Makes physician to physician calls to gather medical appropriate information in order to make medical necessity determinations for services requested.
* Makes medical necessity determinations for grievance and appeals appropriate for their specialty.
* Ensures consistent use of company medical policies when making medical necessity decisions.
* Brings to their supervisors attention, any case review decisions that require Medical Director review or policy interpretation.
* Determine medical necessity of requests using applicable clinical criteria, which may include AIM Appropriateness Guidelines, client-specific health plan medical policy, well established evidenced based guidelines, state mandated policies, and CMS Coverage Determinations, as applicable.
* Perform physician-level case review of utilization requests for procedures and interventions listed above.
* Conduct peer-to-peer consultations with ordering physicians, physician assistants and advanced practice nurses regarding established guidelines and accepted standards of care as it relates to treatments, procedures, imaging, and appropriate sites of service.
* Discuss clinically appropriate alternative treatments, imaging studies and sites of care with ordering providers when consistent with applicable clinical criteria.
* Provide education regarding applicable clinical criteria.
Minimum Requirements:
* Requires MD or DO and Board certification approved by one of the following certifying boards is required, where applicable to duties being performed, American Board of Medical Specialties (ABMS) or American Osteopathic Association (AOA).
* Must possess an active unrestricted medical license to practice medicine or a health profession.
* Minimum of 1 year of experience with clinical case reviews for medical necessity. The minimum of 1 year of experience with clinical case reviews would be waived for the following specific specialties only; Cardiology, Oncology, and Interventional Pain specialties.
* Board certification in a medical specialty required.
Preferred Skills, Capabilities, and Experiences:
* Board Certification in Cardiovascular Disease, Interventional Radiology or Vascular Surgery by the American Board of Internal Medicine or Surgery.
* 3-5 years of clinical practice experience past fellowship training is desirable.
* Demonstrated knowledge of current practice standards in Vascular surgery or Cardiology.
For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $215,255 - $352,236
Locations:
District of Columbia (Washington, DC), Illinois, New York
In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.
* The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law.
Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Who We Are
Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
How We Work
At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ******************************************** for assistance.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
Auto-ApplyDirector - Medical Affairs
Marlborough, MA jobs
A Few Words About Us Integrated Resources, Inc is a premier staffing firm recognized as one of the tri-states most well-respected professional specialty firms. IRI has built its reputation on excellent service and integrity since its inception in 1996. Our mission centers on delivering only the best quality talent, the first time and every time. We provide quality resources in four specialty areas: Information Technology (IT), Clinical Research, Rehabilitation Therapy and Nursing.
Job Description
The Director of Medical Affairs is a physician who will report to the Chief Medical Officer, and will be n Marlborough, MA.- primarily focused on the diagnosis and monitoring of immune and infectious diseases.
The Director of Medical Affairs will be responsible for providing medical and scientific leadership and support for company programs in various stages of clinical development, as well as for approved products on a worldwide basis. The Director of Medical Affairs will supply high quality internal expertise to senior management and will support Marketing, Medical Education, and Business Development in the assessment of new opportunities. The Director of Medical Affairs will also represent the company before thought leaders, learned societies and public bodies.
Responsibilities:
•Contribute to the planning and timely execution of Clinical Development studies, within appropriate standards for compliance, quality, timeliness, and budget
•Support investigator-initiated clinical studies
•Provide high-quality medical opinion to cross-functional company teams
•Conduct advisory board and steering committee meetings
•Collaborate with company colleagues in other regions to define, guide and execute regional strategies and tactics according to corporate objectives
•Provide high quality clinical input in disease-specific strategy plans, as well as publications, educational materials, study protocols, steering committee and advisory board meeting objectives, medical information letters, commercial planning, and on scientific educational grant requests and patient advocacy grant requests
•Recruit and manage the Medical Science Liaison (MSL) team
•Track Medical Affairs activities and performance against goals/budget
•Perform regular literature research and analysis to support the company's strategic intent and identify new scientific opportunities
•Partner with Marketing and Business Development on developing a timely publication strategy
•Interact with key stakeholders, as a therapeutic area medical strategy expert, including thought leaders, learned societies, public bodies and policy makers
Qualifications
Qualifications:
•MD with postgraduate specialization in Infectious Diseases or Immunology
•Industry experience of 5 or more years strongly preferred
•Experience in the conduct of clinical trials preferred
•Proficiency in critical data review and interpretation
•Excellent analytical and interpretative skills and ability to develop and translate medical affairs strategies into actions
•Matrix leadership of cross-functional teams
•Excellent oral and written communication skills, including facilitation of interactive discussions and presentations to large and diverse audiences, including thought leaders
•Customer focus and credibility with customers
•Cultural sensitivity, international experience and more than one spoken language are advantages
•Availability to travel (approx. 25-33%)
Medical Director
Canton, GA jobs
Bridgemill Hospital Animal Hospital in Canton, GA is seeking an Medical Director/Managing Veterinarian to join their caring team. We provide excellent, progressive patient care and client service in an exceptional facility equipped with great diagnostic tools.
We have a collaborative team of trained professionals. Our doctors are supported with at least 2 technicians per doctor. Our 4-day schedules allow for great work life balance. We have an ER clinic nearby for ER referrals.
OUR HOSPITAL
Our 9600 sq ft building boasts 3 exam rooms, surgical suite with monitoring equipment, 2 wet tables, large boarding and outdoor play area. We offer acupuncture, aquapuncture, grooming services, laser treatment, an excellent dentistry program, digital radiography and digital dental, ultrasound, cardio ultrasound, onsite IDEXX labs, and are paper lite with Avimark.
IS THIS YOU…
Our ideal candidate is an experienced (3+ years) who values excellent client education and patient care. We offer mentorship and opportunities for growth. We are seeking a full-time DVM and offer a 4-day schedule with a rotating Saturday. We would love to add a caring and passionate doctor to our team to help us continue to grow and provide compassionate care to our patients and clients!
ABOUT CANTON
Canton, GA is in North Georgia at the foothills of the mountains. We are easy driving distance from the city of Atlanta, and are two hours from the University of GA and two hours Auburn University for college sports fans. We are in a suburban area with a great school district. If you're a lover of the outdoors, nearby Lake Allatoona and Lake Lanier offer boating fishing and watersports. We are ¼ a mile from the 2 best bike trails in the nation.
National Veterinary Associates is a leading global pet care organization united in the love of animals and the people who love them.
At NVA, we're on a mission to improve the lives of pets and the people who love them. That starts by empowering our care teams. We nurture their growth with resources to practice medicine their way. Our network of 1,000 hospitals connects them to a community of professionals who share their passion so they can learn and grow together. Our national presence enables us to deliver technology and innovations that simplify work and expand care for all. At NVA, we're committed to your professional growth. We support your entire career journey, offering opportunities ranging from mentorship to ownership.
NVA offers a comprehensive benefits program including medical, dental, vision, a 401k with employer match, and paid time off (including sick time) for all eligible employees. The team can provide more information about compensation and benefits for your specific location during the process. For positions based in Colorado, NVA provides eligible employees with paid sick and safe leave and public health emergency leave in accordance with the requirements of Colorado's Healthy Families and Workplaces Act.
NVA is 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, age, protected veteran or disabled status, or genetic information. Pursuant to the San Francisco Fair Chance Ordinance, Los Angeles Fair Chance Initiative for Hiring Ordinance, and any other state or local hiring regulations, we will consider for employment any qualified applicant, including those with arrest and conviction records, in a manner consistent with the applicable regulation.
Medical Director-Cardiology Appeals
Atlanta, GA jobs
Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be considered. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.
The Medical Director-Cardiology Appeals is responsible for the review of appeals for physical health medical services, to ensure the appropriate and most cost-effective medical care is received. May be responsible for developing and implementing programs to improve quality, cost, and outcomes. May provide clinical consultation and serve as clinical/strategic advisor to enhance clinical operations. May identify cost of care opportunities. May serve as a resource to staff including Medical Director Associates. May be responsible for an entire clinical program.
How you will make an impact:
* Complete appeal reviews in your specialty daily to ensure timely and consistent responses to members and providers.
* Provide guidance for clinical operational aspects of a program.
* May conduct peer-to-peer clinical reviews with attending physicians or other providers to discuss review determinations
* Serve as a resource and consultant to other areas of the company.
* May be required to represent the company to external entities and/or serve on internal and/or external committees.
* May chair company committees.
* Interpret medical policies and clinical guidelines.
* May lead, develop, direct, and implement clinical and non-clinical activities that impact health care quality cost and outcomes.
* Identify and develop opportunities for innovation to increase effectiveness and quality.
* Work independently with oversight from immediate manager.
* May be responsible for an entire clinical program and/or independently perform clinical reviews.
Minimum Qualifications
* Requires MD or DO and Board certification approved by one of the following certifying boards is required, where applicable to duties being performed: American Board of Medical Specialties (ABMS) or American Osteopathic Association (AOA).
* Board certification in Cardiology.
* Must possess an active unrestricted medical license to practice medicine or a health profession. Unless expressly allowed by state or federal law, or regulation, must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US military base, vessel or any embassy located in or outside of the US.
* Minimum of 10 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
* For Health Solutions and Carelon organizations (including behavioral health) only, minimum of 5 years of experience providing health care is required.
* Additional experience may be required by State contracts or regulations if the Medical Director is filling a role required by a State agency.
* For URAC accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written, and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills. If this job is assigned to any Government Business Division entity, the applicant and incumbent fall under a sensitive position work designation and may be subject to additional requirements beyond those associates outside Government Business Divisions. Requirements include but are not limited to more stringent and frequent background checks and/or government clearances, segregation of duties, principles, role specific training, monitoring of daily job functions, and sensitive data handling instructions. Associates in these jobs must follow the specific policies, procedures, guidelines, etc. as stated by the Government Business Division in which they are employed.
Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Who We Are
Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
How We Work
At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ******************************************** for assistance.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
Auto-ApplyUtilization Management Medical Director- NC Medicaid
Atlanta, GA jobs
Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. Ideal candidate will live in North Carolina but not required. Alternate locations may be considered.
The Medical Director will be responsible for utilization review case management for North Carolina Medicaid. May be responsible for developing and implementing programs to improve quality, cost, and outcomes. May provide clinical consultation and serve as clinical/strategic advisor to enhance clinical operations. May identify cost of care opportunities. May serve as a resource to staff including Medical Director Associates.
How you will make an impact:
* Supports clinicians to ensure timely and consistent responses to members and providers.
* Provides guidance for clinical operational aspects of a program.
* Conducts peer-to-peer clinical reviews with attending physicians or other providers to discuss review determinations, and patients' office visits with providers and external physicians.
* May conduct peer-to-peer clinical appeal case reviews with attending physicians or other ordering providers to discuss review determinations.
* Serves as a resource and consultant to other areas of the company.
* May be required to represent the company to external entities and/or serve on internal and/or external committees.
* May chair company committees.
* Interprets medical policies and clinical guidelines.
* May develop and propose new medical policies based on changes in healthcare.
* Leads, develops, directs, and implements clinical and non-clinical activities that impact health care quality cost and outcomes.
* Identifies and develops opportunities for innovation to increase effectiveness and quality.
Minimum Requirements:
* Requires MD or DO and Board certification approved by one of the following certifying boards is required, where applicable to duties being performed, American Board of Medical Specialties (ABMS) or American Osteopathic Association (AOA).
* Must possess an active unrestricted medical license to practice medicine or a health profession in North Carolina.
* Unless expressly allowed by state or federal law, or regulation, must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US military base, vessel or any embassy located in or outside of the US.
* Minimum of 10 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
* For Health Solutions and Carelon organizations (including behavioral health) only, minimum of 5 years of experience providing health care is required. Additional experience may be required by State contracts or regulations if the Medical Director is filing a role required by a State agency.
Preferred Qualifications:
* Pediatrics board certification preferred.
Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Who We Are
Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
How We Work
At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ******************************************** for assistance.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
Auto-ApplyMedical Director-Dermatology Appeals
Atlanta, GA jobs
Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be considered. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.
The Medical Director-Dermatology Appeals is responsible for the review of appeals for physical health medical services, to ensure the appropriate and most cost-effective medical care is received. May be responsible for developing and implementing programs to improve quality, cost, and outcomes. May provide clinical consultation and serve as clinical/strategic advisor to enhance clinical operations. May identify cost of care opportunities. May serve as a resource to staff including Medical Director Associates. May be responsible for an entire clinical program.
How you will make an impact:
* Complete appeal reviews in your specialty daily to ensure timely and consistent responses to members and providers.
* Provide guidance for clinical operational aspects of a program.
* May conduct peer-to-peer clinical reviews with attending physicians or other providers to discuss review determinations
* Serve as a resource and consultant to other areas of the company.
* May be required to represent the company to external entities and/or serve on internal and/or external committees.
* May chair company committees.
* Interpret medical policies and clinical guidelines.
* May lead, develop, direct, and implement clinical and non-clinical activities that impact health care quality cost and outcomes.
* Identify and develop opportunities for innovation to increase effectiveness and quality.
* Work independently with oversight from immediate manager.
* May be responsible for an entire clinical program and/or independently perform clinical reviews.
Minimum Qualifications
* Requires MD or DO and Board certification approved by one of the following certifying boards is required, where applicable to duties being performed: American Board of Medical Specialties (ABMS) or American Osteopathic Association (AOA).
* Board certification in Dermatology.
* Must possess an active unrestricted medical license to practice medicine or a health profession. Unless expressly allowed by state or federal law, or regulation, must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US military base, vessel or any embassy located in or outside of the US.
* Minimum of 10 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
* For Health Solutions and Carelon organizations (including behavioral health) only, minimum of 5 years of experience providing health care is required.
* Additional experience may be required by State contracts or regulations if the Medical Director is filling a role required by a State agency.
* For URAC accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written, and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills. If this job is assigned to any Government Business Division entity, the applicant and incumbent fall under a sensitive position work designation and may be subject to additional requirements beyond those associates outside Government Business Divisions. Requirements include but are not limited to more stringent and frequent background checks and/or government clearances, segregation of duties, principles, role specific training, monitoring of daily job functions, and sensitive data handling instructions. Associates in these jobs must follow the specific policies, procedures, guidelines, etc. as stated by the Government Business Division in which they are employed.
Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Who We Are
Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
How We Work
At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ******************************************** for assistance.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
Auto-ApplyMedical Director-Dermatology Appeals
Woburn, MA jobs
Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be considered. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.
The Medical Director-Dermatology Appeals is responsible for the review of appeals for physical health medical services, to ensure the appropriate and most cost-effective medical care is received. May be responsible for developing and implementing programs to improve quality, cost, and outcomes. May provide clinical consultation and serve as clinical/strategic advisor to enhance clinical operations. May identify cost of care opportunities. May serve as a resource to staff including Medical Director Associates. May be responsible for an entire clinical program.
How you will make an impact:
* Complete appeal reviews in your specialty daily to ensure timely and consistent responses to members and providers.
* Provide guidance for clinical operational aspects of a program.
* May conduct peer-to-peer clinical reviews with attending physicians or other providers to discuss review determinations
* Serve as a resource and consultant to other areas of the company.
* May be required to represent the company to external entities and/or serve on internal and/or external committees.
* May chair company committees.
* Interpret medical policies and clinical guidelines.
* May lead, develop, direct, and implement clinical and non-clinical activities that impact health care quality cost and outcomes.
* Identify and develop opportunities for innovation to increase effectiveness and quality.
* Work independently with oversight from immediate manager.
* May be responsible for an entire clinical program and/or independently perform clinical reviews.
Minimum Qualifications
* Requires MD or DO and Board certification approved by one of the following certifying boards is required, where applicable to duties being performed: American Board of Medical Specialties (ABMS) or American Osteopathic Association (AOA).
* Board certification in Dermatology.
* Must possess an active unrestricted medical license to practice medicine or a health profession. Unless expressly allowed by state or federal law, or regulation, must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US military base, vessel or any embassy located in or outside of the US.
* Minimum of 10 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
* For Health Solutions and Carelon organizations (including behavioral health) only, minimum of 5 years of experience providing health care is required.
* Additional experience may be required by State contracts or regulations if the Medical Director is filling a role required by a State agency.
* For URAC accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written, and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills. If this job is assigned to any Government Business Division entity, the applicant and incumbent fall under a sensitive position work designation and may be subject to additional requirements beyond those associates outside Government Business Divisions. Requirements include but are not limited to more stringent and frequent background checks and/or government clearances, segregation of duties, principles, role specific training, monitoring of daily job functions, and sensitive data handling instructions. Associates in these jobs must follow the specific policies, procedures, guidelines, etc. as stated by the Government Business Division in which they are employed.
Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Who We Are
Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
How We Work
At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ******************************************** for assistance.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
Auto-ApplyMedical Director-Cardiology Appeals
Woburn, MA jobs
Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be considered. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.
The Medical Director-Cardiology Appeals is responsible for the review of appeals for physical health medical services, to ensure the appropriate and most cost-effective medical care is received. May be responsible for developing and implementing programs to improve quality, cost, and outcomes. May provide clinical consultation and serve as clinical/strategic advisor to enhance clinical operations. May identify cost of care opportunities. May serve as a resource to staff including Medical Director Associates. May be responsible for an entire clinical program.
How you will make an impact:
* Complete appeal reviews in your specialty daily to ensure timely and consistent responses to members and providers.
* Provide guidance for clinical operational aspects of a program.
* May conduct peer-to-peer clinical reviews with attending physicians or other providers to discuss review determinations
* Serve as a resource and consultant to other areas of the company.
* May be required to represent the company to external entities and/or serve on internal and/or external committees.
* May chair company committees.
* Interpret medical policies and clinical guidelines.
* May lead, develop, direct, and implement clinical and non-clinical activities that impact health care quality cost and outcomes.
* Identify and develop opportunities for innovation to increase effectiveness and quality.
* Work independently with oversight from immediate manager.
* May be responsible for an entire clinical program and/or independently perform clinical reviews.
Minimum Qualifications
* Requires MD or DO and Board certification approved by one of the following certifying boards is required, where applicable to duties being performed: American Board of Medical Specialties (ABMS) or American Osteopathic Association (AOA).
* Board certification in Cardiology.
* Must possess an active unrestricted medical license to practice medicine or a health profession. Unless expressly allowed by state or federal law, or regulation, must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US military base, vessel or any embassy located in or outside of the US.
* Minimum of 10 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
* For Health Solutions and Carelon organizations (including behavioral health) only, minimum of 5 years of experience providing health care is required.
* Additional experience may be required by State contracts or regulations if the Medical Director is filling a role required by a State agency.
* For URAC accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written, and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills. If this job is assigned to any Government Business Division entity, the applicant and incumbent fall under a sensitive position work designation and may be subject to additional requirements beyond those associates outside Government Business Divisions. Requirements include but are not limited to more stringent and frequent background checks and/or government clearances, segregation of duties, principles, role specific training, monitoring of daily job functions, and sensitive data handling instructions. Associates in these jobs must follow the specific policies, procedures, guidelines, etc. as stated by the Government Business Division in which they are employed.
Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Who We Are
Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
How We Work
At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ******************************************** for assistance.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
Auto-ApplyUtilization Management Medical Director- NC Medicaid
Woburn, MA jobs
Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. Ideal candidate will live in North Carolina but not required. Alternate locations may be considered.
The Medical Director will be responsible for utilization review case management for North Carolina Medicaid. May be responsible for developing and implementing programs to improve quality, cost, and outcomes. May provide clinical consultation and serve as clinical/strategic advisor to enhance clinical operations. May identify cost of care opportunities. May serve as a resource to staff including Medical Director Associates.
How you will make an impact:
* Supports clinicians to ensure timely and consistent responses to members and providers.
* Provides guidance for clinical operational aspects of a program.
* Conducts peer-to-peer clinical reviews with attending physicians or other providers to discuss review determinations, and patients' office visits with providers and external physicians.
* May conduct peer-to-peer clinical appeal case reviews with attending physicians or other ordering providers to discuss review determinations.
* Serves as a resource and consultant to other areas of the company.
* May be required to represent the company to external entities and/or serve on internal and/or external committees.
* May chair company committees.
* Interprets medical policies and clinical guidelines.
* May develop and propose new medical policies based on changes in healthcare.
* Leads, develops, directs, and implements clinical and non-clinical activities that impact health care quality cost and outcomes.
* Identifies and develops opportunities for innovation to increase effectiveness and quality.
Minimum Requirements:
* Requires MD or DO and Board certification approved by one of the following certifying boards is required, where applicable to duties being performed, American Board of Medical Specialties (ABMS) or American Osteopathic Association (AOA).
* Must possess an active unrestricted medical license to practice medicine or a health profession in North Carolina.
* Unless expressly allowed by state or federal law, or regulation, must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US military base, vessel or any embassy located in or outside of the US.
* Minimum of 10 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
* For Health Solutions and Carelon organizations (including behavioral health) only, minimum of 5 years of experience providing health care is required. Additional experience may be required by State contracts or regulations if the Medical Director is filing a role required by a State agency.
Preferred Qualifications:
* Pediatrics board certification preferred.
Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Who We Are
Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
How We Work
At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ******************************************** for assistance.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
Auto-ApplyAssociate Medical Director
Atlanta, GA jobs
Clinical Operations Associate Medical Director Carelon Medical Benefits Management Radiology Benefit Management/Utilization Review A proud member of the Elevance Health family of companies, Carelon Medical Benefits Management, formerly AIM Specialty Health, is a benefit-management leader in Illinois. Our platform delivers significant cost-of-care savings across an expanding set of clinical domains, including radiology, cardiology and oncology.
Schedule: Monday-Friday 9AM-5PM Central Time
Virtual: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development.
Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.
The Clinical Operations Associate Medical Director is responsible for supporting the medical management staff ensuring timely and consistent medical decisions to members and providers.
How you will make an impact:
* Ensures timely completion of clinical case reviews for their board-certified specialty.
* Makes physician to physician calls to gather medical appropriate information in order to make medical necessity determinations for services requested.
* Makes medical necessity determinations for grievance and appeals appropriate for their specialty.
* Ensures consistent use of medical policies when making medical necessity decisions.
* Brings to their supervisors attention, any case review decisions that require Medical Director review or policy interpretation.
Minimum Requirements:
* Requires MD or DO and Board certification approved by one of the following certifying boards is required, where applicable to duties being performed, American Board of Medical Specialties (ABMS) or American Osteopathic Association (AOA).
* Must possess an active unrestricted medical license to practice medicine or a health profession.
For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $188,051 to $294,910.
Locations:
California, Illinois
In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.
* The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law.
Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Who We Are
Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
How We Work
At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ******************************************** for assistance.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
Auto-ApplyAssociate Medical Director
Woburn, MA jobs
Associate Medical Director: Hybrid Clinical and Administrative This position will be a 50% clinical, 50% administrative role. We are seeking a highly motivated person with strong communication skills to provide medical leadership and strategic guidance. This is an exciting opportunity to contribute to practicing at the highest caliber of medicine and advance your career in a dynamic and collaborative environment.
Individuals working in Emergency, Oncology, Radiology, or Anesthesiology are encouraged to apply, as this position is 50% clinical and aligns with current openings in those departments.
Key Responsibilities:
Clinical Leadership (50%)
* Work collaboratively with specialists and emergency teams to provide exceptional patient care
* Support cross-departmental teamwork, ensuring seamless communication between services
* Offer clinical mentorship and guidance to doctors and technicians
Administrative & Leadership Duties (50%)
* Work closely with the Medical Director and leadership team to oversee hospital operations
* Implement and refine hospital protocols, policies, and quality improvement initiatives
* Foster staff development, team morale, and a culture of collaboration
* Address patient care issues, client concerns, and referral relationships
* Assist with strategic planning and future hospital growth
Qualifications:
* DVM/VMD from an accredited institution
* Active Massachusetts veterinary license (or eligibility to obtain one)
* Proven leadership experience with excellent communication and interpersonal skills
* Passion for mentorship, collaboration, and elevating patient care
About Us:
Massachusetts Veterinary Referral Hospital (MVRH) is a 36,000 square foot hospital, located 11 miles north of Boston, is home to one of the premier level 1 emergency and specialty centers in New England. Mass Vet is a proud member of the Ethos Veterinary Health network, a 24-hour emergency and specialty hospital dedicated to delivering compassionate, cutting-edge medical care to companion animals. Since 2000, we've been serving the Greater Boston area with a commitment to excellence, collaboration, and innovation.
We recently completed a state-of-the-art renovation, expanding our hospital to better serve our patients, clients, and team. Our upgraded facility now includes:
* Nine fully equipped operating rooms and one large endoscopy suite
* A new, expanded ICU for enhanced critical care including a dedicated dialysis suite and new isolation area to ensure top-tier infection control.
* Newly upgraded Fluoroscopy suite, MRI & advanced CT imaging for improved diagnostics and interventional procedures
* A newly upgraded employee breakroom stocked with amenities like a flavored seltzer machine, coffee station, massagers, and puzzles -because we believe in caring for our team as much as we care for our patients
* An on-staff social worker to support both clients and employees, fostering a healthy and compassionate workplace.
Why Join MVRH?
* Cutting-Edge Facility: Work in a newly renovated hospital with top-of-the-line equipment and technology
* Collaborative Team: Join a multidisciplinary team of specialists dedicated to innovation and excellence in veterinary medicine
* Wellness & Support: Enjoy breakroom perks, mental health resources, and an on-staff social worker to support both clients and employees
* Professional Growth: Be part of a learning-focused environment with ongoing development opportunities
If you are a passionate and experienced veterinarian looking for a leadership role in a thriving, team-focused hospital, we encourage you to apply and be a part of the exciting future at Massachusetts Veterinary Referral Hospital.
How to Apply:
Please submit your resume and cover letter detailing your clinical and leadership experience to Amanda Schultz (***************************).
Ethos Veterinary Health is at the forefront of innovation and world-class medicine. As the premier network of over 140 specialty and emergency hospitals across North America, Ethos brings together a dedicated community of more than 1,500 specialized doctors providing care for nearly 2 million pets annually. The integrated and collaborative network of veterinary professionals utilize state-of-the-art technology and a scientific, evidence-based approach to deliver compassionate, unparalleled care and rewarding careers. Committed to revolutionizing veterinary medicine, Ethos sets the standard in veterinary excellence. Discover more at EthosVet.com.
Our commitments to the industry, the profession, our teammates, and our patients, will not change, and in fact will be stronger than ever, as we forge new ground as this new dynamic community.
Ethos Veterinary Health offers a comprehensive benefits program including medical, dental, vision, a 401k with employer match, and paid time off (including sick time) for all eligible employees. The team can provide more information about compensation and benefits for your specific location during the process. For positions based in Colorado, EVH provides eligible employees with paid sick and safe leave and public health emergency leave in accordance with the requirements of Colorado's Healthy Families and Workplaces Act.
Ethos Veterinary Health is 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, age, protected veteran or disabled status, or genetic information. Pursuant to the San Francisco Fair Chance Ordinance, Los Angeles Fair Chance Initiative for Hiring Ordinance, and any other state or local hiring regulations, we will consider for employment any qualified applicant, including those with arrest and conviction records, in a manner consistent with the applicable regulation.
Easy ApplyAssociate Center Medical Director
Hiawassee, GA jobs
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 Associate 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:
$231,876 - $331,251 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
Auto-ApplyLicensed Clinical Director - LICSW, LMHC, Licensed Psychologist
West Springfield Town, MA jobs
The Center for Human Development (CHD), is seeking a Licensed Clinical Director to oversee the clinical services within CHD's Congregate Care residential programs. The Clinical Director works directly with the Program Managers to ensure that services are always of the highest quality. They maintain open communication, actively supports the team model and ensures all agency standards, policies, and procedures are utilized.
Your role as a Licensed Clinical Director:
The Licensed Clinical Director is responsible for the direct supervision of the program clinicians. The Clinical Director will assist in the development and implementation of individual, group and family therapy, creation of comprehensive treatment plans, intake planning, discharge planning, community support coordination and collaboration, facilitating staff trainings, and crisis intervention. Additionally, the Clinical Director, who is independently licensed (LICSW, LMHC, Licensed Psychologist), will conduct CANS Assessments and Bio-Psychosocial assessments. Additionally, the Clinical Director will provide limited individual and group therapy in conjunction with the program clinician.
The Clinical Director works within the Agency's team model, establishing open communication, support, and accountability among co-workers. He/she along with the program director will develop, coordinate, and facilitate trainings related to the population and services provided. He/she will regularly collaborate with DCF, local medical facilities, psychiatric, educational, and human service providers in order to ensure best practices in the programs at all times.
The Clinical Director will be available to provide immediate consultation and support to the program staff and clients in times of crisis. The Clinical Director will work some extended evening, weekend, and holiday hours to respond to shifts in milieu dynamics and the need for immediate youth or family support.
Take advantage of a competitive pay range of $75,000-$80,000 that includes a phenomenal benefits like, Dental, Health and Life insurance. Paid time off, earned vacation time and paid holidays just to name a few.
At Center for Human Development (CHD) Care Finds a Way:
The Center for Human Development (CHD) provides a broad range of high quality, community-oriented human services dedicated to promoting, enhancing, and protecting the dignity and welfare of people in need. At CHD we are celebrating differences, inclusion is not just a policy- it is a daily practice. Multicultural, multilingual, and fluent in sign language, CHD is a reflection of those we serve.
Connect with our team today:
If this sounds like the right job for you, do not wait - apply today to join our team. We look forward to hearing from you!
Clinical Director
South Hadley, MA jobs
The Center for Human Development (CHD) is currently seeking a Licensed or Licensed Eligible Clinical Director for its Aster House program located in South Hadley. Aster House is a co-occurring residential treatment facility for 16 residents. The Clinical Director works alongside the Program Director to assure residents receive the best possible treatment and are successful in their recovery.
Your role as a Clinical Director:
The Clinical Director works collaboratively with other community agencies. Duties include the development and implementation of individual and group therapy, creation of comprehensive treatment plans, discharge planning, community support coordination and collaboration, facilitating staff trainings, and crisis intervention.
Requirements:
Master's Degree in related field
Licensed or Licensed Eligible
Significant knowledge of co-occurring disorders and treatment
5 years' experience in clinical treatment positions
Experience facilitating groups in a residential treatment setting
Familiarity with DMH, DPH, and BSAS service systems is preferred
Supervisory experience preferred
Success Factors:
The Clinical Director should actively support the philosophy of the Agency and maintain a high level of commitment to program staff. Personality traits should include:
cheerful, outward-going personality
high energy level; self-initiated
philosophical commitment to the concept of human potential
directive and goal-oriented
assertive and confident
performs well under stress and in the event of crisis
open, direct interpersonal style; works well as team member
sense of vision
sensitivity to issues of diversity and oppression
dependable
The salary range is $75,000-$83,000. This Full time on-site opportunity is complemented with a phenomenal benefit package that includes, Dental, Health and Life insurance, a flexible schedule, paid time off, earned vacation time and paid holidays just to name a few.
At Center for Human Development, CHD, Care Finds A Way
The Center for Human Development (CHD) provides a broad range of high quality, community-oriented human services dedicated to promoting, enhancing, and protecting the dignity and welfare of people in need. At CHD we are celebrating differences, inclusion is not just a policy- it is a daily practice. Multicultural, multilingual, and fluent in sign language, CHD is a reflection of those we serve.
Connect with our team today!
If this sounds like the right job for you, do not wait - apply today to join our team. We look forward to hearing from you!