425 Clinical Director jobs in La Riviera
Water Justice Clinical Director (ACAD PRG MGT OFCR 5)
Posted 9 days ago
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Location Davis
Full/Part Time Full Time
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FOR HR USE ONLY
EEO/AA StatementA Culture of Opportunity and Belonging
At UC Davis, we're committed to solving life's most urgent challenges and building a healthier, more resilient world. We believe in growing through every challenge, continually striving to improve, and welcoming new perspectives that strengthen our community. We recognize that a vibrant and innovative organization values both individual strengths and shared purpose. The best ideas often emerge when people with different experiences come together.
As you consider joining UC Davis, we invite you to explore our Principles of Community, our Clinical Strategic Plan and strategic vision for research and education. We believe you belong here. The University of California, Davis is an Equal Opportunity Employer. All qualified applicants will be considered for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, age or protected veteran status.
To view the University of California's Anti-Discrimination Policy, please visit:
Because we want you to feel seen and valued, our recruitment process at UC Davis supports openness and authenticity. Research shows that some individuals hesitate to apply unless they meet every qualification. You may be an excellent fit for this role-or the next one. We encourage you to apply even if your experience doesn't match every listed requirement. #YouBelongHere
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Director, Clinical Quality
Posted 2 days ago
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Job Description
Evolent partners with health plans and providers to achieve better outcomes for people with most complex and costly health conditions. Working across specialties and primary care, we seek to connect the pieces of fragmented health care system and ensure people get the same level of care and compassion we would want for our loved ones.
Evolent employees enjoy work/life balance, the flexibility to suit their work to their lives, and autonomy they need to get things done. We believe that people do their best work when they're supported to live their best lives, and when they feel welcome to bring their whole selves to work. That's one reason why diversity and inclusion are core to our business.
Join Evolent for the mission. Stay for the culture.
**What You'll Be Doing:**
The Director, Clinical Quality is a pivotal role, spearheading continuous clinical quality improvement initiatives and managing high-priority quality improvement projects, encompassing primary and specialty care and integration. Utilizing the DMAIC (Define, Measure, Analyze, Improve, Control) process, this role will work cross-functionally to enhance patient outcomes, streamline processes, and foster a culture of clinical excellence in member care. The role also involves driving the development and implementation of clinical performance metrics, ensuring effective quality measurement, data analysis, and the execution of actionable improvement strategies to enhance clinical outcomes and operational efficiency. Additionally, the Director, Clinical Quality will support a portfolio of performance initiatives to achieve strategic and financial goals.
**Key Responsibilities:**
**Innovation:**
Develops common set of core quality metrics for core sub-specialties that align with national measure to improve patient outcomes and minimize provider complexity.
o Oncology
o Cardiology
o MSK
o Radiology
**Stakeholder Collaboration:**
o Serve as a liaison between clinical teams, analytics, partner operations, strategic accounts, and leadership to ensure alignment on quality improvement priorities and goals.
o Synthesize and present findings to leadership and develop visually appealing content that effectively communicates findings and recommendations.
o Facilitate regular communication and updates on metric development, trends, and improvement initiatives.
o Engage cross-department leaders and stakeholders to design and execute initiatives across clients/markets.
**Documentation and Communication:**
o Create clear, accessible, and actionable documentation for clinical performance metrics.
o Communicate progress and results of quality initiatives to stakeholders, including executive leadership and clinical teams.
**Quality Data Analysis and Insights:**
o Analyze quality data to identify trends, variations, and opportunities for improvement.
o Interpret findings and collaborate with stakeholders to understand root causes and potential impacts.
o Use available data to determine whether implemented initiatives achieve metrics of success, working cross-functionally to refine approach as needed.
**Quality Improvement Initiatives:**
o Develop and implement action plans based on data-driven insights to address identified trends and gaps in performance.
o Partner with clinical, operational, and analytics teams to monitor the impact of improvement efforts and refine strategies as needed.
o Define & Understand Scope: Establish clear project objectives and goals in alignment with organizational priorities. Collaborate with Medical Directors and analytics teams to identify key clinical performance metrics.
o Measure and Analyze: Collect data to measure current process performance and establish baselines. Analyze quality data to identify trends, variations, and improvement opportunities. Understand root causes and impacts.
o Improve and Control: Implement evidence-based interventions to enhance quality and reduce variability. Monitor key performance indicators to sustain improvements and make necessary adjustments.
**Performance Management:**
o Manage high-priority performance initiatives through all phases of design and execution, including post-go-live tracking, to realize strategic and financial goals.
o Maintain a catalog of performance initiatives, including their description, high-level sizing, and other key criteria for prioritization.
o Develop and maintain project management processes, tools, and templates for performance initiatives.
o Ensure strict compliance with federal and state regulations and company policies, procedures, and processes.
**Qualifications (Required and Preferred):**
- Bachelor's degree in healthcare administration, nursing, public health, or a related field. In lieu of degree, 5+ years of experience in clinical quality or process improvement.
- 2+ years of clinical quality improvement experience in healthcare, preferably with a focus on specialty care and quality.
- Strong analytical skills with proficiency in statistical analysis and process mapping.
- Excellent leadership, communication, and interpersonal skills.
- Ability to work independently and collaboratively in a fast-paced, dynamic environment.
- Certification in Six Sigma, Lean, or other quality improvement methodologies (preferred).
- Strong project management skills: history of taking initiative and effectively managing projects and processes.
- Experience with managed care, specialty care, cardiology, and/or provider engagement.
- Experience with medical expense reporting and initiative development.
- Strong Microsoft PowerPoint, Excel, and Word skills.
- Outstanding written and oral presentation skills.
**Key Competencies:**
- Deep understanding of quality improvement frameworks (e.g., Lean, Six Sigma, PDSA cycles).
- Proficiency in data analysis tools and software (e.g., Excel, BI Portal, or similar).
- Strong organizational and project management skills to manage multiple initiatives simultaneously.
- A commitment to advancing clinical excellence and improving patient outcomes.
**To comply with HIPAA security standards (45 C.F.R. sec. 164.308 (a) (3)), identity verification may be required as part of the application process. This is collected for compliance and security purposes and only reviewed if an applicant advances to the final interview state. Reasonable accommodations are available upon request.**
**Technical Requirements:**
We require that all employees have the following technical capability at their home: High speed internet over 10 Mbps and, specifically for all call center employees, the ability to plug in directly to the home internet router. These at-home technical requirements are subject to change with any scheduled re-opening of our office locations.
**Evolent is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, or disability status.** **If you need reasonable accommodation to access the information provided on this website, please contact** ** ** **for further assistance.**
The expected base salary/wage range for this position is $122,500. This position is also eligible for a bonus component that would be dependent on pre-defined performance factors. As part of our total compensation package, Evolent is proud to offer comprehensive benefits (including health insurance benefits) to qualifying employees. All compensation determinations are based on the skills and experience required for the position and commensurate with experience of selected individuals, which may vary above and below the stated amounts.
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Director, Clinical Operations
Posted 2 days ago
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Job Description
Our comprehensive portfolio of over 400 products is fully integrated and built to serve our customers across the full spectrum of their eye health needs throughout their lives. Our iconic brand is built on the deep trust and loyalty of our customers established over our 170-year history. We have a significant global research, development, manufacturing and commercial footprint of approximately 13,000 employees and a presence in approximately 100 countries, extending our reach to billions of potential customers across the globe. We have long been associated with many of the most significant advances in eye health, and we believe we are well positioned to continue leading the advancement of eye health in the future.
**Position Summary** **:**
Is responsible for the implementation and oversight of clinical study operations by organizing and coordinating with other relevant parties the planning, implementation, management, execution and completion of clinical studies according to applicable regulations and guidance, ICH and GCP, and Bausch & Lomb SOPs within agreed-upon timeframes and budget. Also responsible for effective communication within the corporation (and with external entities, where appropriate) of the issues and actions related to the successful completion of these studies. May serve as the primary project team representative for Clinical Operations.
**Major areas of Responsibility** **:**
Clinical Operations:
+ Manage and/or oversee the development process for critical study documents (e.g., protocol, amendments, IB, ICF, and CRFs). Will also work closely with members of other functional areas to provide input on study-related documents and issues (DMP, SAP, drug/device supplies, CSR, etc.).
+ Provides clinical operations input in the identification, evaluation, and selection of CROs and vendors (e.g., central labs, central IRB, IVRS, etc.).
+ Manage the identification, evaluation, and selection of investigators/sites.
+ Ongoing assessment, evaluation and management of internal and external resources.
+ Ensure study supply requirements are met.
+ Responsible for the appropriate communication with and maintenance of clinical study sites including training of site personnel in the study protocol and other study-specific procedures.
+ Supervise clinical operations team to ensure all study activities are completed in accordance with applicable regulations and guidance, ICH, GCP and B&L SOPs.
+ Communicate with relevant global team members, other B&L departments (e.g., R&D/Project Management, Clinical/Medical Affairs, Biometrics, Regulatory Affairs, Quality Assurance, Pharmacovigilance/GPSS and Drug/Device Safety, and Clinical Supplies), and external consultants to ensure study objectives are being met and provide the operations director and/or senior management with timely updates on progress and changes in scope, schedule, and resources.
+ Organize investigator and expert meetings relevant to the indication and assist with the organization and management of DSMBs and Data Review Committees, as necessary.
+ Prepare study timelines and budgets and ensuring study execution is aligned with these targets.
+ Supervise clinical staff and vendors to ensure all study activities are completed in accordance with applicable regulations and guidance, ICH, GCP and B&L SOPs.
+ Responsible for the quality of all study-related documentation (e.g., Trial Master File, site qualification and initiation visits reports, interim monitoring visit reports, clinical monitoring plan, informed consents, CRF completion guidelines, pharmacy manual, etc.) during study start-up and throughout the life of the project to ensure that procedures are followed in an appropriate and consistent manner.
+ Oversee the preparation of procedures for the conduct and monitoring of clinical research such as Clinical Monitoring Plans, procedures for reporting of adverse events, CRF completion guidelines, Study Manual, etc.
+ Liaise with PVG/GPSS and provide clinical operations support and guidance for the ongoing surveillance of the safety of patients in clinical trials by reviewing reported AEs and SAEs and assure proper reporting of the events to the IRBs/REBs/ECs.
+ Liaise with Data Management to review data discrepancies and ensure that data clarification forms (queries) are appropriately handled by the CRAs and responded to by the site/investigator in a timely manner. May assist in the review of queries to determine criticality of the DCF during data clean-up and lock process.
+ Liaise with vendors and study site personnel and clinical investigators to provide study related guidance and answers to operational issues.
Budgets and Forecasts:
+ Provide input to Finance to forecast study expenditures and resourcing needs.
+ Review RFPs and proposals from external vendors.
+ Ensure subordinates and vendors manage and monitor study related expenses to meet forecast.
Regulatory Reports:
+ Provide Clinical Operations support in the timely coordination and execution of clinical study reports.
+ Assist in the review of regulatory reports to ensure that reports accurately reflect proper interpretation of the clinical study findings.
+ Assist to ensure annual IND/IDE and IB/ROPI updates are completed in an accurate and timely manner.
+ Provide Clinical Operations support to the Regulatory Affairs department.
Leadership:
+ Manage in-house team of CRAs, CTAs and/or CTMs for one or more studies to ensure execution of all studies in a timely and efficient manner.
+ Provide leadership, training, and development support to the study team.
+ May lead meetings (face-to-face, teleconferences, etc.) with external vendors ensuring problems are identified and issues are resolved quickly and efficiently.
+ May serve as a representative on internal committees/teams for Clinical Operations or cross-functional activities.
+ Foster a dynamic, matrixed working environment by appropriately challenging processes, inspiring a shared vision, enabling others to act, leading by example, and encouraging study team members to meet and/or exceed expectations.
+ Encourage professional growth of personnel through regular training sessions, and by acting as a resource to clinical staff. May lead training sessions.
+ Provide guidance and comments on SOPs revisions. May act as a leader of a SOP sub-committee for SOP revisions.
+ May visit sites with CRAs as needed to provide hands-on training as well as to discuss study related issues and problems with the Principal Investigator and/or site staff.
+ Share/present knowledge and information with appropriate departmental, project, or study team members for training purposes.
**POSITION REQUIREMENTS** **:**
+ Strong knowledge of Good Clinical Practices (GCP), clinical trials management (including site monitoring), scientific methods, research design, regulatory compliance, and clinical data management.
+ Minimum 10-12 years experience in the industry with a minimum of 6 years of managing clinical trials.
+ Minimum of 5 - 6 years experience in managing and training clinical personnel (Executive CRAs, CRAs, project assistants).
+ Experience leading device studies in Ophthalmology is a plus
+ Strong planning and organizational skills with ability to multi-task and plan activities as it relates to management of clinical trials.
+ Experience leading and working within cross-functional teams.
+ Experience in managing CROs and external vendors.
+ Excellent written and verbal communication skills and strong interpersonal skills in order to interface with physicians, outside vendors, consultants, team members and various audiences.
+ Ability to problem solve, build teams, and to lead and motivate others.
+ Effectively work independently as well as within a team matrix.
+ Financial management skills as applicable to overseeing project expenditures and forecasts.
+ Advanced computer skills (Microsoft applications, spreadsheets and data displays, etc.)
+ Willing and able to travel.
**We offer competitive salary & excellent benefits including:**
+ Medical, Dental, Eye Health, Disability and Life Insurance begins on your hire date
+ 401K Plan with company match and ongoing company contribution
+ Paid time off - vacation (3 weeks - prorated upon hire), floating holidays and sick time
+ Employee Stock Purchase Plan with company match
+ Employee Incentive Bonus
+ Tuition Reimbursement (select degrees)
+ Ongoing performance feedback and annual compensation review
This position may be available in the following location(s): ((location_obj))
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status.
For U.S. locations that require disclosure of compensation, the starting pay for this role is between $170,000.00 and $205,000.00. The estimated salary range reflects an anticipated range for this position. The actual base salary offered may depend on a variety of factors. U.S. based employees may be eligible for short-term and/or long-term incentives. They may also be eligible to participate in medical, dental, vision insurance, disability and life insurance, a 401(k) plan and company match, a tuition reimbursement program (select degrees), company holidays, and well-being benefits, among others. U.S. based employees are also eligible to receive sick time, floating holidays and paid vacation.
Job Applicants should be aware of job offer scams perpetrated through the use of the Internet and social media platforms. To learn more please read Bausch + Lomb's Job Offer Fraud Statement ( .
Our Benefit Programs:Employee Benefits: Bausch + Lomb ( must be authorized to work for ANY employer in the U.S. We are unable to sponsor or take over sponsorship of an employment Visa at this time.
Lead Director, Clinical Innovation
Posted today
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Job Description
As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.
**Position Summary**
The Lead Director of Clinical Innovation is a critical leader and has responsible for managing and successfully driving the strategic analysis portfolio and initiatives that solves key business problems and creates new sources of value for Mental Well Being within Aetna's Clinical Solutions business unit.
+ Leads, partners, and collaborates with cross-functional teams, to include key internal and external stakeholders, to analyze, develop, test, and implement innovative solutions
+ Drives or guides innovation scope using an Aetna's Clinical Innovation repeatable methodology across incubation and acceleration phases; idea concept and solution development, proof of value management and evaluation, pilot planning and delivery, scaled readiness, value realization and monitoring. Manages and develops interventions and facilitates working sessions as well as delivers all required analysis, reporting and presentation materials.
+ Supports the evaluation of new concepts, emerging innovation trends and offerings benchmarking within the healthcare industry and subsequently develops these trends into new and innovative solutions that solve key business problems and deliver break through value.
+ Responsible for developing, motivating and managing a high-performing team members to meet organizational goals and objectives while effectively managing change.
+ Managing and building a strong team through formal training, diverse assignments, and coaching, mentoring and other development techniques
+ Contribute to a motivated work environment by working collaboratively and effectively with key stakeholders across Health Care Business and Aetna Mental Well Being to achieve common goals.
+ Supporting CVS Health in attracting, retaining, and engaging a diverse and inclusive consumer-centric workforce that delivers on our purpose and reflects the communities in which we work, live, and serve.
**Required Qualifications**
+ 8+ years leading complex teams with knowledge of the healthcare system including customer service, clinical operations and plan administrative functions.
+ Strong interpersonal and communication skills, effectively communicate key messages to executive leaders and internal/external stake holders.
+ Strong verbal and written communication skills; proven ability to deliver presentations to senior leadership team members
+ Strong data and analytics skills to include modeling, synthesizing information and deriving key insights.
+ Strong understanding within clinical and health plan operations and value creation methodologies
+ Successful experience in strategy, innovation and/or portfolio management within healthcare industry
+ High ability to consistently produce and create value and meet/exceed committed performance
+ High ability to drive new innovation in highly cross-functional environments Effectively lead and motivate teams to ensure high standards of performance and outcomes
**Preferred Qualifications**
+ Ability to manage and grow a team of individuals to achieve departmental goals at a rapid pace
+ Experience creating new capabilities and/or project offerings that result in new value Conceptual and structured thinker that has a high degree to generate and translate concepts and ideas into effective strategies that achieve results
+ Ability to embrace change, uncertainly and shifting priorities and plans to accommodate broader changing objectives and demands
+ Demonstrated relationship management skills at the senior level; capacity to quickly build and maintain credible relationships at varying levels of the organization simultaneously.
+ Experience with enterprise-wide and/or cross-functional large scale initiatives with high degree of complexity.
+ 5+ years with demonstrated leadership and experience with the following: Innovation, analytics, generative AI, business process optimization, enterprise business portfolio management/consulting, financial analysis, strategic planning, risk management
**Education**
Bachelor's Degree or equivalent work experience
Master's Degree preferred
**Pay Range**
The typical pay range for this role is:
$100,000.00 - $231,540.00
This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. This position also includes an award target in the company's equity award program.
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
**Great benefits for great people**
We take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:
+ **Affordable medical plan options,** a **401(k) plan** (including matching company contributions), and an **employee stock purchase plan** .
+ **No-cost programs for all colleagues** including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
+ **Benefit solutions that address the different needs and preferences of our colleagues** including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.
For more information, visit anticipate the application window for this opening will close on: 07/31/2025
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.
Utilization Management Medical Director, Clinical Performance - California license - Remote
Posted 2 days ago
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Job Description
Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.
Looking for a chance to drive measurable and meaningful improvement in the use of evidence-based medicine, patient safety, practice variation and affordability? You can make a difference at UnitedHealth Group and our family of businesses in serving our Medicare, Medicaid and commercial members and plan sponsors. Be part of changing the way health care is delivered while working with a Fortune 4 industry leader.
We are currently seeking a Utilization Management Medical Director to join our Clinical Performance team. This team is responsible for conducting hospital and post-acute utilization reviews for the state of California. The Medical Directors work with groups of nurses and support staff to manage inpatient care utilization.
You’ll enjoy the flexibility to work remotely * as you take on some tough challenges.
Primary Responsibilities:
- Work to improve quality and promote evidence-based medicine
- Provide information on quality and efficiency to doctors, patients and customers to inform care choices and drive improvement
- Support initiatives that enhance quality throughout our national network
- Ensure the right service is provided at the right time for each member
- Work with medical director teams focusing on inpatient care management, clinical coverage review, member appeals clinical review, medical claim review and provider appeals clinical review
Success in this technology-heavy role requires exceptional leadership skills, the knowledge and confidence to make autonomous decisions and an ability to thrive in a production-driven setting.
You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications:
- MD or DO degree
- Active, unrestricted California state license
- Current board certification in ABMS or AOA specialty
- 5+ years of clinical practice experience post residency
- Solid understanding of and concurrence with evidence-based medicine (EBM) and managed care principles
Preferred Qualifications:
- Hands-on utilization and/or quality management experience
- Project management or active project participation experience
- Substantial experience in using electronic clinical systems
*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy
The salary range for this role is $238,000 to $357,500 annually based on full-time employment. Salary Range is defined as total cash compensation at target. The actual range and pay mix of base and bonus is variable based upon experience and metric achievement. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group 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). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.
Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.
UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
Utilization Management Medical Director, Clinical Performance - California license - Remote
Posted 2 days ago
Job Viewed
Job Description
Looking for a chance to drive measurable and meaningful improvement in the use of evidence-based medicine, patient safety, practice variation and affordability? You can make a difference at UnitedHealth Group and our family of businesses in serving our Medicare, Medicaid and commercial members and plan sponsors. Be part of changing the way health care is delivered while working with a Fortune 4 industry leader.
We are currently seeking a Utilization Management Medical Director to join our Clinical Performance team. This team is responsible for conducting hospital and post-acute utilization reviews for the state of California. The Medical Directors work with groups of nurses and support staff to manage inpatient care utilization.
You'll enjoy the flexibility to work remotely * as you take on some tough challenges.
**Primary Responsibilities:**
+ Work to improve quality and promote evidence-based medicine
+ Provide information on quality and efficiency to doctors, patients and customers to inform care choices and drive improvement
+ Support initiatives that enhance quality throughout our national network
+ Ensure the right service is provided at the right time for each member
+ Work with medical director teams focusing on inpatient care management, clinical coverage review, member appeals clinical review, medical claim review and provider appeals clinical review
Success in this technology-heavy role requires exceptional leadership skills, the knowledge and confidence to make autonomous decisions and an ability to thrive in a production-driven setting.
You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
**Required Qualifications:**
+ MD or DO degree
+ Active, unrestricted California state license
+ Current board certification in ABMS or AOA specialty
+ 5+ years of clinical practice experience post residency
+ Solid understanding of and concurrence with evidence-based medicine (EBM) and managed care principles
**Preferred Qualifications:**
+ Hands-on utilization and/or quality management experience
+ Project management or active project participation experience
+ Substantial experience in using electronic clinical systems
*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
Compensation for this specialty generally ranges from $238,000 to $357,500. Total cash compensation includes base pay and bonus and is based on several factors including but not limited to local labor markets, education, work experience and may increase over time based on productivity and performance in the role. We comply with all minimum wage laws as applicable. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives.
**Application Deadline:** This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.
_At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission._
_UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations._
_UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment._
Senior Director, Global Clinical Development CNS
Posted 7 days ago
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Job Description
**Position Summary** The purpose of this position is to lead the clinical development activities in support of domestic and international clinical development initiatives. The Senior Director, GCD works in a multidisciplinary matrix environment and supports the further development and commercialization of pharmaceutical products, for global launches. This position requires deep understanding of all aspects of the drug development process from early clinical stages to post commercialization; with emphasis on the large global clinical trials and regulatory filing activities. The Senior Director, GCD is responsible for all the clinical development activities for the projects assigned and for the successful implementation and completion of trials leading to NDA and/or Global filings. **Key Job Responsibilities** + Conceives, implements, and analyzes drug development programs, including: + Understanding pharmacology of drugs and unmet medical needs. + Formulating a rationale to develop the drug in accordance with a clinical and regulatory strategy. + Working with experts and consultants in the field to refine a clinical development strategy. + Designing clinical trials for the purpose of meeting specific objectives. + Anticipating and addressing future commercial and clinical development needs, based on the clinicalcharacter of the compound. + Implements clinical development programs, including: + Co-authoring global clinical development plans with all practical elements. + Leading and motivating the clinical development team to operationalize the clinical develop strategy,i.e., clinical trials management. + Partnering with internal and external clinical experts and consultants to optimize the scientific integrity of the methodology and ensure the safety of clinical subjects. + Leading clinical trial projects to ensure all aspects of the clinical trial project plan (e.g., enrollment, database lock) are achieved on time and with the highest quality. + Developing and leading formal presentations of results to the medical community, in written, verbal, andvisual formats. + Analyzes and interprets the results of clinical programs in collaboration with clinical, biometric and clinical pharmacology experts. + Partners with biostatistics, medical writers, and external consultants to understand and present the results ofclinical development programs. + Partners with internal decision makers to evaluate critical decision points. + Acts as a signatory for the medical monitoring team. + Contributes to corporate initiatives by participating in continuous process improvement to meet companyobjectives as well as evaluates in-licensing opportunities and/or additional life cycle management opportunities. + Participates in NDA development, submission and defense. + Lectures at national and international meetings, scientific advisory board meetings, and data safety monitoring boards. + Mentors junior team members. **Knowledge, Skills, Competencies, Education, and Experience** Required: + A clinician (M.D., or D.O.) preferably a psychiatrist or neurologist including prior management experience (direct or indirect). Supplementary degrees (e.g., Ph.D., M.P.H., M.B.A.) are a plus. Board certification in Psychiatry and Neurology is highly desired. Minimum of five years of clinical research experience (post Academia). + Requires thorough knowledge of clinical medicine and/or clinical pharmacology and associated disciplines (e.g. biostatistics, data management, medical writing). + An advanced understanding of clinical medicine and science. + Advanced understanding of drug development principles and clinical trial implementation and management. + Complete understanding of the global regulatory requirements. + Working knowledge of marketing and commercialization. + Complete understanding of overall corporate goals with a fundamental grasp of basic principles to work in a business setting. + Demonstrated experience in all developmental phases including evaluation of pre-clinical or in-licensing candidates' potential for meeting an unmet medical need, establishing early clinical safety and proof of concept, conduct of global trials for registration, and implementation of late-stage life-cycle management strategies, + Demonstrated experience in leading a successful regulatory filing. + Ability to work across different therapeutic areas and different stages of clinical development. + Demonstrated ability to manage and motivate clinical team members (e.g., internal staff and external investigators/consultants). + Strong communication and presentation skills. + Strong computer skills with demonstrated experience in working with the Microsoft suite of programs (Word, Excel, PowerPoint, and Outlook). + Knows how/when to apply organizational policy or procedures to a variety of situations. **Physical Demands and Work Environment** Travel (approximately 30 **%** ) See document Physical Demands and Work Environment for further requirements. **Competencies** **Accountability for Results -** Stay focused on key strategic objectives, be accountable for high standards of performance, and take an active role in leading change. **Strategic Thinking & Problem Solving -** Make decisions considering the long-term impact to customers, patients, employees, and the business. **Patient & Customer Centricity -** Maintain an ongoing focus on the needs of our customers and/or key stakeholders. **Impactful Communication -** Communicate with logic, clarity, and respect. Influence at all levels to achieve the best results for Otsuka. **Respectful Collaboration -** Seek and value others' perspectives and strive for diverse partnerships to enhance work toward common goals. **Empowered Development -** Play an active role in professional development as a business imperative. Minimum $245,454.00 - Maximum $381,110.00, plus incentive opportunity: The range shown represents a typical pay range or starting salary for candidates hired to perform the work. Other elements may be used to determine actual salary such as the candidate's job experience, specific skills, and comparison to internal incumbents currently in role. This information is provided to applicants in accordance with states and local laws. **Company benefits** : Comprehensive medical, dental, vision, prescription drug coverage, company provided basic life, accidental death & dismemberment, short-term and long-term disability insurance, tuition reimbursement, student loan assistance, a generous 401(k) match, flexible time off, paid holidays, and paid leave programs as well as other company provided benefits. Come discover more about Otsuka and our benefit offerings; . **Disclaimer:** This job description is intended to describe the general nature and level of the work being performed by the people assigned to this position. It is not intended to include every job duty and responsibility specific to the position. Otsuka reserves the right to amend and change responsibilities to meet business and organizational needs as necessary. Otsuka is an equal opportunity employer. All qualified applicants are encouraged to apply and will be given consideration for employment without regard to race, color, sex, gender identity or gender expression, sexual orientation, age, disability, religion, national origin, veteran status, marital status, or any other legally protected characteristic. If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation, if you are unable or limited in your ability to apply to this job opening as a result of your disability. You can request reasonable accommodations by contacting Accommodation Request ( ) . **Statement Regarding Job Recruiting Fraud Scams** At Otsuka we take security and protection of your personal information very seriously. Please be aware individuals may approach you and falsely present themselves as our employees or representatives. They may use this false pretense to try to gain access to your personal information or acquire money from you by offering fictitious employment opportunities purportedly on our behalf. Please understand, Otsuka will **never** ask for financial information of any kind or for payment of money during the job application process. We do not require any financial, credit card or bank account information and/or any payment of any kind to be considered for employment. We will also not offer you money to buy equipment, software, or for any other purpose during the job application process. If you are being asked to pay or offered money for equipment fees or some other application processing fee, even if claimed you will be reimbursed, this is not Otsuka. These claims are fraudulent and you are strongly advised to exercise caution when you receive such an offer of employment. Otsuka will also never ask you to download a third-party application in order to communicate about a legitimate job opportunity. Scammers may also send offers or claims from a fake email address or from Yahoo, Gmail, Hotmail, etc, and not from an official Otsuka email address. Please take extra caution while examining such an email address, as the scammers may misspell an official Otsuka email address and use a slightly modified version duplicating letters. To ensure that you are communicating about a legitimate job opportunity at Otsuka, please only deal directly with Otsuka through its official Otsuka Career website . Otsuka will not be held liable or responsible for any claims, losses, damages or expenses resulting from job recruiting scams. If you suspect a position is fraudulent, please contact Otsuka's call center at: . If you believe you are the victim of fraud resulting from a job recruiting scam, please contact the FBI through the Internet Crime Complaint Center at: , or your local authorities. Otsuka America Pharmaceutical Inc., Otsuka Pharmaceutical Development & Commercialization, Inc., and Otsuka Precision Health, Inc. ("Otsuka") does not accept unsolicited assistance from search firms for employment opportunities. All CVs/resumes submitted by search firms to any Otsuka employee directly or through Otsuka's application portal without a valid written search agreement in place for the position will be considered Otsuka's sole property. No fee will be paid if a candidate is hired by Otsuka as a result of an agency referral where no pre-existing agreement is in place. Where agency agreements are in place, introductions are position specific. Please, no phone calls or emails.
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Senior Director, Global Clinical Development CNS
Posted 2 days ago
Job Viewed
Job Description
The purpose of this position is to lead the clinical development activities in support of domestic and international clinical development initiatives.
The Senior Director, GCD works in a multidisciplinary matrix environment and supports the further development and commercialization of pharmaceutical products, for global launches. This position requires deep understanding of all aspects of the drug development process from early clinical stages to post commercialization; with emphasis on the large global clinical trials and regulatory filing activities.
The Senior Director, GCD is responsible for all the clinical development activities for the projects assigned and for the successful implementation and completion of trials leading to NDA and/or Global filings.
**Key Job Responsibilities**
+ Conceives, implements, and analyzes drug development programs, including:
+ Understanding pharmacology of drugs and unmet medical needs.
+ Formulating a rationale to develop the drug in accordance with a clinical and regulatory strategy.
+ Working with experts and consultants in the field to refine a clinical development strategy.
+ Designing clinical trials for the purpose of meeting specific objectives.
+ Anticipating and addressing future commercial and clinical development needs, based on the clinicalcharacter of the compound.
+ Implements clinical development programs, including:
+ Co-authoring global clinical development plans with all practical elements.
+ Leading and motivating the clinical development team to operationalize the clinical develop strategy,i.e., clinical trials management.
+ Partnering with internal and external clinical experts and consultants to optimize the scientific integrity of the methodology and ensure the safety of clinical subjects.
+ Leading clinical trial projects to ensure all aspects of the clinical trial project plan (e.g., enrollment, database lock) are achieved on time and with the highest quality.
+ Developing and leading formal presentations of results to the medical community, in written, verbal, andvisual formats.
+ Analyzes and interprets the results of clinical programs in collaboration with clinical, biometric and clinical pharmacology experts.
+ Partners with biostatistics, medical writers, and external consultants to understand and present the results ofclinical development programs.
+ Partners with internal decision makers to evaluate critical decision points.
+ Acts as a signatory for the medical monitoring team.
+ Contributes to corporate initiatives by participating in continuous process improvement to meet companyobjectives as well as evaluates in-licensing opportunities and/or additional life cycle management opportunities.
+ Participates in NDA development, submission and defense.
+ Lectures at national and international meetings, scientific advisory board meetings, and data safety monitoring boards.
+ Mentors junior team members.
**Knowledge, Skills, Competencies, Education, and Experience**
Required:
+ A clinician (M.D., or D.O.) preferably a psychiatrist or neurologist including prior management experience (direct or indirect). Supplementary degrees (e.g., Ph.D., M.P.H., M.B.A.) are a plus. Board certification in Psychiatry and Neurology is highly desired. Minimum of five years of clinical research experience (post Academia).
+ Requires thorough knowledge of clinical medicine and/or clinical pharmacology and associated disciplines (e.g. biostatistics, data management, medical writing).
+ An advanced understanding of clinical medicine and science.
+ Advanced understanding of drug development principles and clinical trial implementation and management.
+ Complete understanding of the global regulatory requirements.
+ Working knowledge of marketing and commercialization.
+ Complete understanding of overall corporate goals with a fundamental grasp of basic principles to work in a business setting.
+ Demonstrated experience in all developmental phases including evaluation of pre-clinical or in-licensing candidates' potential for meeting an unmet medical need, establishing early clinical safety and proof of concept, conduct of global trials for registration, and implementation of late-stage life-cycle management strategies,
+ Demonstrated experience in leading a successful regulatory filing.
+ Ability to work across different therapeutic areas and different stages of clinical development.
+ Demonstrated ability to manage and motivate clinical team members (e.g., internal staff and external investigators/consultants).
+ Strong communication and presentation skills.
+ Strong computer skills with demonstrated experience in working with the Microsoft suite of programs (Word, Excel, PowerPoint, and Outlook).
+ Knows how/when to apply organizational policy or procedures to a variety of situations.
**Physical Demands and Work Environment**
Travel (approximately 30 **%** )
See document Physical Demands and Work Environment for further requirements.
**Competencies**
**Accountability for Results -** Stay focused on key strategic objectives, be accountable for high standards of performance, and take an active role in leading change.
**Strategic Thinking & Problem Solving -** Make decisions considering the long-term impact to customers, patients, employees, and the business.
**Patient & Customer Centricity -** Maintain an ongoing focus on the needs of our customers and/or key stakeholders.
**Impactful Communication -** Communicate with logic, clarity, and respect. Influence at all levels to achieve the best results for Otsuka.
**Respectful Collaboration -** Seek and value others' perspectives and strive for diverse partnerships to enhance work toward common goals.
**Empowered Development -** Play an active role in professional development as a business imperative.
Minimum $245,454.00 - Maximum $381,110.00, plus incentive opportunity: The range shown represents a typical pay range or starting salary for candidates hired to perform the work. Other elements may be used to determine actual salary such as the candidate's job experience, specific skills, and comparison to internal incumbents currently in role. This information is provided to applicants in accordance with states and local laws.
**Company benefits** : Comprehensive medical, dental, vision, prescription drug coverage, company provided basic life, accidental death & dismemberment, short-term and long-term disability insurance, tuition reimbursement, student loan assistance, a generous 401(k) match, flexible time off, paid holidays, and paid leave programs as well as other company provided benefits.
Come discover more about Otsuka and our benefit offerings; .
**Disclaimer:**
This job description is intended to describe the general nature and level of the work being performed by the people assigned to this position. It is not intended to include every job duty and responsibility specific to the position. Otsuka reserves the right to amend and change responsibilities to meet business and organizational needs as necessary.
Otsuka is an equal opportunity employer. All qualified applicants are encouraged to apply and will be given consideration for employment without regard to race, color, sex, gender identity or gender expression, sexual orientation, age, disability, religion, national origin, veteran status, marital status, or any other legally protected characteristic.
If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation, if you are unable or limited in your ability to apply to this job opening as a result of your disability. You can request reasonable accommodations by contacting Accommodation Request ( ) .
**Statement Regarding Job Recruiting Fraud Scams**
At Otsuka we take security and protection of your personal information very seriously. Please be aware individuals may approach you and falsely present themselves as our employees or representatives. They may use this false pretense to try to gain access to your personal information or acquire money from you by offering fictitious employment opportunities purportedly on our behalf.
Please understand, Otsuka will **never** ask for financial information of any kind or for payment of money during the job application process. We do not require any financial, credit card or bank account information and/or any payment of any kind to be considered for employment. We will also not offer you money to buy equipment, software, or for any other purpose during the job application process. If you are being asked to pay or offered money for equipment fees or some other application processing fee, even if claimed you will be reimbursed, this is not Otsuka. These claims are fraudulent and you are strongly advised to exercise caution when you receive such an offer of employment.
Otsuka will also never ask you to download a third-party application in order to communicate about a legitimate job opportunity. Scammers may also send offers or claims from a fake email address or from Yahoo, Gmail, Hotmail, etc, and not from an official Otsuka email address. Please take extra caution while examining such an email address, as the scammers may misspell an official Otsuka email address and use a slightly modified version duplicating letters.
To ensure that you are communicating about a legitimate job opportunity at Otsuka, please only deal directly with Otsuka through its official Otsuka Career website .
Otsuka will not be held liable or responsible for any claims, losses, damages or expenses resulting from job recruiting scams. If you suspect a position is fraudulent, please contact Otsuka's call center at: . If you believe you are the victim of fraud resulting from a job recruiting scam, please contact the FBI through the Internet Crime Complaint Center at: , or your local authorities.
Otsuka America Pharmaceutical Inc., Otsuka Pharmaceutical Development & Commercialization, Inc., and Otsuka Precision Health, Inc. ("Otsuka") does not accept unsolicited assistance from search firms for employment opportunities. All CVs/resumes submitted by search firms to any Otsuka employee directly or through Otsuka's application portal without a valid written search agreement in place for the position will be considered Otsuka's sole property. No fee will be paid if a candidate is hired by Otsuka as a result of an agency referral where no pre-existing agreement is in place. Where agency agreements are in place, introductions are position specific. Please, no phone calls or emails.
Medical Director - Clinical Advocacy and Support - Hawaii preferred - Remote (Sacramento)
Posted today
Job Viewed
Job Description
5 days ago Be among the first 25 applicants
Get AI-powered advice on this job and more exclusive features.
Lensa is a career site that helps job seekers find great jobs in the US. We are not a staffing firm or agency. Lensa does not hire directly for these jobs, but promotes jobs on LinkedIn on behalf of its direct clients, recruitment ad agencies, and marketing partners. Lensa partners with DirectEmployers to promote this job for UnitedHealth Group.
Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.
Clinical Advocacy & Support has an unrelenting focus on the customer journey and ensuring we exceed expectations as we deliver clinical coverage and medical claims reviews. Our role is to empower providers and members with the tools and information needed to improve health outcomes, reduce variation in care, deliver seamless experience, and manage health care costs.
The Medical Director provides physician support to Enterprise Clinical Services operations, the organization responsible for the initial clinical review of service requests for Enterprise Clinical Services. The Medical Director collaborates with Enterprise Clinical Services leadership and staff to establish, implement, support, and maintain clinical and operational processes related to benefit coverage determinations, quality improvement and cost effectiveness of service for members. The Medical Director's activities primarily focus on the application of clinical knowledge in various utilization management activities with a focus on pre-service benefit and coverage determination or medical necessity (according to the benefit package), and on communication regarding this process with both network and non-network physicians, as well as other Enterprise Clinical Services.
The Medical Director collaborates with a multidisciplinary team and is actively involved in the management of medical benefits. The collaboration often involves the members primary care provider or specialist physician. It is the primary responsibility of the medical director to ensure that the appropriate and most cost-effective quality medical care is provided to members.
Youll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities
- Conduct coverage reviews based on individual member plan benefits and national and proprietary coverage review policies, render coverage determinations
- Document clinical review findings, actions, and outcomes in accordance with policies, and regulatory and accreditation requirements
- Engage with requesting providers as needed in peer-to-peer discussions
- Be knowledgeable in interpreting existing benefit language and policies in the process of clinical coverage reviews
- Participate in virtual daily clinical rounds as requested
- Communicate and collaborate with network and non-network providers in pursuit of accurate and timely benefit determinations for plan participants while educating providers on benefit plans and medical policy
- Communicate and collaborate with other internal partners
- Call coverage rotation
Required Qualifications
- M.D or D.O.
- Active unrestricted license to practice medicine
- Board certification in an ABMS specialty with Internal Medicine preferred but will consider General Surgery, Rheumatology, ER, Family Medicine, ENT or PM&R
- 3+ years of clinical practice experience after completing residency training
- Sound understanding of Evidence Based Medicine (EBM)
- Proven solid PC skills, specifically using MS Word, Outlook, and Excel
- Hawaii residence and license preferred but will consider other locations and licenses
- ER, Internist or Surgeon with specialties preferred for some of the roles
- Experience in utilization and clinical coverage review
- Proven excellent oral, written, and interpersonal communication skills, facilitation skills
- Proven data analysis and interpretation aptitude
- Proven innovative problem-solving skills
- Proven excellent presentation skills for both clinical and non-clinical audiences
- All employees working remotely will be required to adhere to UnitedHealth Groups Telecommuter Policy.
Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyoneof every race, gender, sexuality, age, location and incomedeserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes an enterprise priority reflected in our mission.
UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
If you have questions about this posting, please contact Seniority level
- Seniority level Mid-Senior level
- Employment type Full-time
- Job function Health Care Provider
- Industries Internet Publishing
Referrals increase your chances of interviewing at Lensa by 2x
Sign in to set job alerts for Medical Director roles.Sacramento, CA 174,070.00- 374,920.00 4 weeks ago
Associate Chief Medical Information Officer, ACMIO Medical Director - SIU (Special Investigations Unit) Spine Telecommute Medical Review Stream Physician Senior Medical Recruiter - Remote - Nationwide Remote Experienced PMHNP for Private Practice in CA Clinical Scheduler - Anesthesiology - Remote - Nationwide Territory Manager - Oncology Medical Sales (Sacramento, CA)Were unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI.
#J-18808-LjbffrMedical Director - Clinical Advocacy and Support - Hawaii preferred - Remote (Sacramento)
Posted today
Job Viewed
Job Description
5 days ago Be among the first 25 applicants
Get AI-powered advice on this job and more exclusive features.
Lensa is a career site that helps job seekers find great jobs in the US. We are not a staffing firm or agency. Lensa does not hire directly for these jobs, but promotes jobs on LinkedIn on behalf of its direct clients, recruitment ad agencies, and marketing partners. Lensa partners with DirectEmployers to promote this job for UnitedHealth Group. Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together. Clinical Advocacy & Support has an unrelenting focus on the customer journey and ensuring we exceed expectations as we deliver clinical coverage and medical claims reviews. Our role is to empower providers and members with the tools and information needed to improve health outcomes, reduce variation in care, deliver seamless experience, and manage health care costs. The Medical Director provides physician support to Enterprise Clinical Services operations, the organization responsible for the initial clinical review of service requests for Enterprise Clinical Services. The Medical Director collaborates with Enterprise Clinical Services leadership and staff to establish, implement, support, and maintain clinical and operational processes related to benefit coverage determinations, quality improvement and cost effectiveness of service for members. The Medical Director's activities primarily focus on the application of clinical knowledge in various utilization management activities with a focus on pre-service benefit and coverage determination or medical necessity (according to the benefit package), and on communication regarding this process with both network and non-network physicians, as well as other Enterprise Clinical Services. The Medical Director collaborates with a multidisciplinary team and is actively involved in the management of medical benefits. The collaboration often involves the members primary care provider or specialist physician. It is the primary responsibility of the medical director to ensure that the appropriate and most cost-effective quality medical care is provided to members. Youll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities
- Conduct coverage reviews based on individual member plan benefits and national and proprietary coverage review policies, render coverage determinations
- Document clinical review findings, actions, and outcomes in accordance with policies, and regulatory and accreditation requirements
- Engage with requesting providers as needed in peer-to-peer discussions
- Be knowledgeable in interpreting existing benefit language and policies in the process of clinical coverage reviews
- Participate in virtual daily clinical rounds as requested
- Communicate and collaborate with network and non-network providers in pursuit of accurate and timely benefit determinations for plan participants while educating providers on benefit plans and medical policy
- Communicate and collaborate with other internal partners
- Call coverage rotation
- M.D or D.O.
- Active unrestricted license to practice medicine
- Board certification in an ABMS specialty with Internal Medicine preferred but will consider General Surgery, Rheumatology, ER, Family Medicine, ENT or PM&R
- 3+ years of clinical practice experience after completing residency training
- Sound understanding of Evidence Based Medicine (EBM)
- Proven solid PC skills, specifically using MS Word, Outlook, and Excel
- Hawaii residence and license preferred but will consider other locations and licenses
- ER, Internist or Surgeon with specialties preferred for some of the roles
- Experience in utilization and clinical coverage review
- Proven excellent oral, written, and interpersonal communication skills, facilitation skills
- Proven data analysis and interpretation aptitude
- Proven innovative problem-solving skills
- Proven excellent presentation skills for both clinical and non-clinical audiences
- All employees working remotely will be required to adhere to UnitedHealth Groups Telecommuter Policy.
- Seniority level Mid-Senior level
- Employment type Full-time
- Job function Health Care Provider
- Industries Internet Publishing
Referrals increase your chances of interviewing at Lensa by 2x
Sign in to set job alerts for Medical Director roles.Sacramento, CA 174,070.00- 374,920.00 4 weeks ago
Associate Chief Medical Information Officer, ACMIO Medical Director - SIU (Special Investigations Unit) Spine Telecommute Medical Review Stream Physician Senior Medical Recruiter - Remote - Nationwide Remote Experienced PMHNP for Private Practice in CA Clinical Scheduler - Anesthesiology - Remote - Nationwide Territory Manager - Oncology Medical Sales (Sacramento, CA)Were unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI.
#J-18808-Ljbffr