13 Healthcare Professional jobs in District Of Columbia
Emergency Medical Services (EMS) Professor - Part-Time (Washington)
Posted today
Job Viewed
Job Description
- Who We Are
Located in the scenic Puget Sound area with Mount Rainier in the distance, Tacoma is the third largest city in Washington State with a thriving and diverse community of over 200,000 residents. Tacoma Community College (TCC) was built on the ancestral territory of Coast Salish peoples, specifically the Puyallup and Squaxin Island Tribes. The 1854 Medicine Creek Treaty forcibly removed them to Reservations to make way for colonizers; we recognize the privilege of utilizing this land has come at great cost. We honor the resilience of the Puyallup and Squaxin Island people, who still live here, defend their rights, and contribute greatly to the well-being of our community. Our institution aims to increase partnerships and community ties with the local indigenous populations. Moreover, TCC stands in solidarity with Black Lives Matter and the Black community by further strengthening collaboration with the Black Student Union as well as community entities such as the Tacoma-Pierce County Black Collective, the Tacoma Urban League, and local black-owned businesses. In addition, we strongly support the Stop Asian Hate movement and have an active Asian Pacific Islander Student Club as well as an Asian and Pacific Islander Faculty and Staff Coalition. TCC is committed to developing more culturally responsive curricula by infusing and incorporating more educational content focused on the lives, experiences, and contributions of Native, Black, Asian, and other marginalized communities. We continually strive to become an anti-racist institution.
To grow our workforce, we are seeking creative, collaborative faculty who are reflective of the diverse community we serve. Tacoma Community College is a public Associate- and Bachelor's-granting institution that serves a student-body of approximately 12,000 students. Our students are 27% students of color, 60% female, and have a median age of 26. We embrace our identity as a community college. Our faculty are engaged in innovative work to improve student retention and program completion, and community success. According to the Community College Survey of Student Engagement, TCC ranks high on measures of active learning and academic challenge, thanks to our creative and scholarly faculty.
We are specifically focusing on improved support for traditionally marginalized populations, including Black/African- American, Indigenous, People of Color, Dreamers, justice-involved, immigrants and refugees, Veterans, people with disabilities, and the LGBTQ+ community. To this end, TCC seeks applicants who:
- Value intellectual curiosity and innovative teaching
- Welcome difference and model respectful interaction with others
- Recognize and honor the important role that diversity brings to an educational community
- Are committed to educating a racially and socioeconomically diverse student population
- Are committed to teaching in a community college setting
- Care deeply about student success
- Intentionally support and promote efforts related to equity, diversity, and inclusion
- Honor TCC's mission promoting equitable access to educational opportunities
- Reflect the diversity of our community
Part-Time Faculty positions at the college are open continuously and reviewed on a quarter-by-quarter basis. Individuals who apply to the applicant pool are considered active for a period of 12 months from the application date and may be contacted when vacancies occur. Submitting an application does not guarantee that a position will be available or offered.
Position Summary
Prepare and teach a variety of courses in the classroom, skills lab, and/or field settings for the EMS program including EMT - Basic and Paramedic courses. Work closely with the Program Chair, Medical Director, and other EMS faculty. This position reports to the Dean for Health, Business and Professional Services.
- Essential Functions
- Prepare course syllabi and schedules; prepare and teach classes and labs; prepare testing materials and evaluate student-learning outcomes.
- Ability to serve as liaison with clinical sites.
- Advise students regarding didactic, clinical and field performance.
- Participate actively in departmental committees and other responsibilities, including curriculum review and design.
- Serve on campus committees; participate in division and college activities.
- Perform related duties as assigned.
- Qualifications
Minimum Qualifications
- EMT, AEMT, or Paramedic Certification.
- Three (3) years of full time recent experience in emergency medical services (EMS).
- Teaching experience in the field of EMS.
- Currently endorsed as a Senior EMT Instructor (SEI) or eligibility to obtain status within one year of hire.
- Ability to meet Washington State vocational certification requirements.
- Proficient with word processing and spreadsheet software.
- AHA BLS Provider Instructor or ability to obtain it within 2 months of hire.
Preferred Qualifications- Bachelor's Degree or higher in a related field from an accredited college or university.
Conditions of Employment- Successfully complete a criminal history background check prior to employment.
- Ability to teach a full-time teaching schedule with a set schedule.
- Proof of completed COVID-19 Vaccination
- Ethics, integrity, and sound professional judgment.
- An appreciation of diversity and a commitment to cultural awareness and sensitivity in the workplace.
- Knowledge and experience in a variety of emergency medical system settings/ facilities, including demonstrated ability to function effectively as an EMS team member.
- Evidence of leadership skills and commitment to EMS professions. Commitment to remain current in EMS.
- Experience integrating the computer as a tool to support EMS instruction.
- Experience working as a team member with other faculty and staff.
- Strong interpersonal skills and ability to work with community members, health care professionals, students, faculty and administration.
- Instructional skills using a variety of teaching methodologies.
- Strong organizational skills and attention to detail.
- Commitment to functioning as an effective team member.
- Ability to integrate the computer as a tool to support traditional instructional techniques.
- Application Process
Application Material & Procedures
Complete application packages must include the following:
- Tacoma Community College online application.
- Resume & cover letter describing how your educational background and experience align with the responsibilities and qualifications.
- UNOFFICIAL copies of transcripts for all colleges and universities attended.
This is a part time faculty position contracted on a quarterly basis. Part time faculty salary range is per credit hour starting at $1,182.22 to $,422.22 . Salary ranges are subject to any approved COLA's after initial placement. If applicable, Lab credit hours are paid at 50% the credit hour rate. Professional Services hours are paid at a flat rate of 44.00- 44.00 per hour. Placement on the faculty salary schedule will commensurate with educational background and experience per the 2024 Faculty Negotiated Agreement (Article 4.00 Academic Employee Compensation ). Part-time faculty may become eligible for healthcare and retirement benefits at the beginning of the second consecutive quarter of half-time or more employment at one or more Washington state institutions of higher education. Half time is determined based on each institution's definition of full time. Members may 'stack' workloads between other qualifying colleges. A part-time faculty member must qualify each quarter they teach, to maintain eligibility. Once eligible, part-time faculty will be notified of their benefit and retirement options. Tacoma Community College offers offers one personal leave day per academic year if the PTF have been awarded a multi-quarter appointment. Sick leave is awarded every quarter based on the full-time equivalent teaching percent . If eligibility requirements are met, a comprehensive health care benefits package for you and your dependents includes medical, dental and vision insurance. Life and long- term disability insurance plans reduced tuition for the employee ; and retirement benefits are also provided. For more information, please visit our employment page/employment benefits: . A collective bargaining agreement exist and membership in the TCC Federation of Teachers or payment of a service fee and is available anytime upon hire. Evening and off campus assignments may be a part of the instructional load. Flexibility is required to meet the needs of the department. Degrees must be from accredited colleges or universities recognized by the U.S. Department of Education and verified by National Student Clearinghouse. International degrees will be verified for U.S. equivalency.
Tacoma Community College values diversity and is an Equal Opportunity Employer and Educator. Tacoma Community College provides equal opportunity in educat
Director of Medical Staff Services, Days, Medical Staff Office (Washington)
Posted today
Job Viewed
Job Description
With over 150 years of caring for our community and each other in the Washington DC area, Howard University Hospital has a world-renowned reputation for high-quality, patient-centric care. Howard University Hospital is the nations only teaching hospital located on the campus of a Historically Black University and has created a superior learning environment, with groundbreaking research and positive patient outcomes.
Howard University Hospital seeks to hire a Director of Medical Staff Services who will embrace our reach and historic tradition of excellence. If you want to make a difference in someones life every day, consider a position with a team of professionals who are doing just that, making a difference.
This position is full time, Monday-Friday 40 hour week, with some nights and weekends as needed.
As the Director of Medical Staff Services, you will:
- Directs and coordinates the activities of the Medical Staff Office to meet the needs of Adventist Health Care, the Medical Staff and Allied Health Professionals including development of budget, goals as well as human resource management.
- Develops and oversees the credentialing and privileging process for initial, reappointment, and all other credentialing aspects while ensuring use of standardized processes and business rules across the Adventist HealthCare System.
- Collaborates to develop and maintain a comprehensive credentialing database and prepares reports and summaries.
- Oversees regulatory compliance for all Medical Staff aspects of TJC, NCQA, URAQ, CMS, CARF and other Federal and State regulations as well as Urgent Care Center Accreditation.This includes required Intra-cycle Monitoring. Develops action plans, provides follow-up and problem resolution for any standard or regulation that is not met or has recently changed to ensure compliance.
- Oversees physician legal and risk management issues including disciplinary actions, fair hearings, and reports to regulatory bodies such as the National Practitioner Databank and the Maryland Board of Physicians.
- Provides guidance, support and serves as a resource to the Rockville Campus Chief Medical Officers, Medical Directors, and Senior Medical Staff Leaders.
- Develops and implements effective organizational and department goals and objectives for credentialing activities that meets regulatory, legal and Medical Staff Bylaws requirements as well as Malcolm Baldrige Award requirements.
- Oversees and ensures compliance, meeting preparation, submission of recommendations and reports from the Medical Staff Sections, Medical Staff Departments, Credentials Committee, Medical Executive Committee and Bylaws to the Hospitals Governing Board.
- Develops and coordinates Focused Professional Practice Evaluation (FPPE) and Ongoing Professional Practice Evaluation (OPPE) processes used to access Medical Staff and Allied Health Professional Staff competency and compliance with AHC, Medical Staff and all other regulatory standards.
- Develops and revises Medical Staff Forms, Manuals and Policies including delineation of privileges, department/section rules and regulations, privileging criteria and other documents as well as Medical Staff Bylaws, Medical Staff Rules and Regulations and Credentials Manuals while ensuring regulatory compliance.
- Provides delegated credentialing services for the Adventist Health Care Managed Care Department for a variety of organizations, including IPA, PHOs, and health plans while ensuring NCQA and URAQ regulations
- Oversees the Undergraduate Medical Education Program for processing and registration of Medical and PA Students, Residents and Fellows.
- Oversees Maryland Department of Health electronic death certificate training and access, Federal Drug Enforcement Agency electronic prescribing of narcotics, and Maryland Board of Physicians fingerprinting and background check processes.
- Ensures Cerner & HIPPA training and compliance of EMR access process for all Physician Office Staff, Billers and Insurance Reviewers as well as deactivation of access including Medical and Allied Health Professional Staff.
- Oversees the Annual and Ongoing Requirements as well as submission of all Trainings and Documents, i.e. Flu, PPD, Computer and Classroom trainings for the Medical Staff and Allied Health Professional Staff.
- Assumes other duties and responsibilities that are related and appropriate to the position and area.The above responsibilities are a general description of the level and nature of the work assigned to this classification and are not to be considered as all-inclusive.
Qualified Candidates will possess:
- Bachelors degree in Business Administration or a HealthCare Administration is required
- Ten (10) years experience in Medical Staff Services required
- Minimum of five years progressive experience in Medical Staff management, credentialing, and privileging with a significant part of that serving as the primary point of contact for regulatory surveys required
- CPCS (Certified Provider of Credentialing Services) Certification by the National Association of Medical Staff Services required
- CPMSM (Certified Professional of Medical Staff Management) Certification by the National Association of Medical Staff Services required
- Certified in Business Project Management preferred
Knowledge of regulatory agency requirements for medical staff, credentialing and privileging required
COVID-19 Vaccination:
Howard University Hospital requires all external applicants to be fully vaccinated for COVID-19 before commencing employment. External Applicants may be required to furnish proof of vaccination and, if offered, may elect to be vaccinated at a designated Howard University Hospital location.
Director of Medical Staff Services, Days, Medical Staff Office (Washington)
Posted today
Job Viewed
Job Description
With over 150 years of caring for our community and each other in the Washington DC area, Howard University Hospital has a world-renowned reputation for high-quality, patient-centric care. Howard University Hospital is the nations only teaching hospital located on the campus of a Historically Black University and has created a superior learning environment, with groundbreaking research and positive patient outcomes.
Howard University Hospital seeks to hire a Director of Medical Staff Services who will embrace our reach and historic tradition of excellence. If you want to make a difference in someones life every day, consider a position with a team of professionals who are doing just that, making a difference.
This position is full time, Monday-Friday 40 hour week, with some nights and weekends as needed.
As the Director of Medical Staff Services, you will:
- Directs and coordinates the activities of the Medical Staff Office to meet the needs of Adventist Health Care, the Medical Staff and Allied Health Professionals including development of budget, goals as well as human resource management.
- Develops and oversees the credentialing and privileging process for initial, reappointment, and all other credentialing aspects while ensuring use of standardized processes and business rules across the Adventist HealthCare System.
- Collaborates to develop and maintain a comprehensive credentialing database and prepares reports and summaries.
- Oversees regulatory compliance for all Medical Staff aspects of TJC, NCQA, URAQ, CMS, CARF and other Federal and State regulations as well as Urgent Care Center Accreditation.This includes required Intra-cycle Monitoring. Develops action plans, provides follow-up and problem resolution for any standard or regulation that is not met or has recently changed to ensure compliance.
- Oversees physician legal and risk management issues including disciplinary actions, fair hearings, and reports to regulatory bodies such as the National Practitioner Databank and the Maryland Board of Physicians.
- Provides guidance, support and serves as a resource to the Rockville Campus Chief Medical Officers, Medical Directors, and Senior Medical Staff Leaders.
- Develops and implements effective organizational and department goals and objectives for credentialing activities that meets regulatory, legal and Medical Staff Bylaws requirements as well as Malcolm Baldrige Award requirements.
- Oversees and ensures compliance, meeting preparation, submission of recommendations and reports from the Medical Staff Sections, Medical Staff Departments, Credentials Committee, Medical Executive Committee and Bylaws to the Hospitals Governing Board.
- Develops and coordinates Focused Professional Practice Evaluation (FPPE) and Ongoing Professional Practice Evaluation (OPPE) processes used to access Medical Staff and Allied Health Professional Staff competency and compliance with AHC, Medical Staff and all other regulatory standards.
- Develops and revises Medical Staff Forms, Manuals and Policies including delineation of privileges, department/section rules and regulations, privileging criteria and other documents as well as Medical Staff Bylaws, Medical Staff Rules and Regulations and Credentials Manuals while ensuring regulatory compliance.
- Provides delegated credentialing services for the Adventist Health Care Managed Care Department for a variety of organizations, including IPA, PHOs, and health plans while ensuring NCQA and URAQ regulations
- Oversees the Undergraduate Medical Education Program for processing and registration of Medical and PA Students, Residents and Fellows.
- Oversees Maryland Department of Health electronic death certificate training and access, Federal Drug Enforcement Agency electronic prescribing of narcotics, and Maryland Board of Physicians fingerprinting and background check processes.
- Ensures Cerner & HIPPA training and compliance of EMR access process for all Physician Office Staff, Billers and Insurance Reviewers as well as deactivation of access including Medical and Allied Health Professional Staff.
- Oversees the Annual and Ongoing Requirements as well as submission of all Trainings and Documents, i.e. Flu, PPD, Computer and Classroom trainings for the Medical Staff and Allied Health Professional Staff.
- Assumes other duties and responsibilities that are related and appropriate to the position and area.The above responsibilities are a general description of the level and nature of the work assigned to this classification and are not to be considered as all-inclusive.
Qualified Candidates will possess:
- Bachelors degree in Business Administration or a HealthCare Administration is required
- Ten (10) years experience in Medical Staff Services required
- Minimum of five years progressive experience in Medical Staff management, credentialing, and privileging with a significant part of that serving as the primary point of contact for regulatory surveys required
- CPCS (Certified Provider of Credentialing Services) Certification by the National Association of Medical Staff Services required
- CPMSM (Certified Professional of Medical Staff Management) Certification by the National Association of Medical Staff Services required
- Certified in Business Project Management preferred
Knowledge of regulatory agency requirements for medical staff, credentialing and privileging required
COVID-19 Vaccination:
Howard University Hospital requires all external applicants to be fully vaccinated for COVID-19 before commencing employment. External Applicants may be required to furnish proof of vaccination and, if offered, may elect to be vaccinated at a designated Howard University Hospital location.
Director of Medical Staff Services, Days, Medical Staff Office (Washington)
Posted today
Job Viewed
Job Description
With over 150 years of caring for our community and each other in the Washington DC area, Howard University Hospital has a world-renowned reputation for high-quality, patient-centric care. Howard University Hospital is the nations only teaching hospital located on the campus of a Historically Black University and has created a superior learning environment, with groundbreaking research and positive patient outcomes.
Howard University Hospital seeks to hire a Director of Medical Staff Services who will embrace our reach and historic tradition of excellence. If you want to make a difference in someones life every day, consider a position with a team of professionals who are doing just that, making a difference.
This position is full time, Monday-Friday 40 hour week, with some nights and weekends as needed.
As the Director of Medical Staff Services, you will:
- Directs and coordinates the activities of the Medical Staff Office to meet the needs of Adventist Health Care, the Medical Staff and Allied Health Professionals including development of budget, goals as well as human resource management.
- Develops and oversees the credentialing and privileging process for initial, reappointment, and all other credentialing aspects while ensuring use of standardized processes and business rules across the Adventist HealthCare System.
- Collaborates to develop and maintain a comprehensive credentialing database and prepares reports and summaries.
- Oversees regulatory compliance for all Medical Staff aspects of TJC, NCQA, URAQ, CMS, CARF and other Federal and State regulations as well as Urgent Care Center Accreditation.This includes required Intra-cycle Monitoring. Develops action plans, provides follow-up and problem resolution for any standard or regulation that is not met or has recently changed to ensure compliance.
- Oversees physician legal and risk management issues including disciplinary actions, fair hearings, and reports to regulatory bodies such as the National Practitioner Databank and the Maryland Board of Physicians.
- Provides guidance, support and serves as a resource to the Rockville Campus Chief Medical Officers, Medical Directors, and Senior Medical Staff Leaders.
- Develops and implements effective organizational and department goals and objectives for credentialing activities that meets regulatory, legal and Medical Staff Bylaws requirements as well as Malcolm Baldrige Award requirements.
- Oversees and ensures compliance, meeting preparation, submission of recommendations and reports from the Medical Staff Sections, Medical Staff Departments, Credentials Committee, Medical Executive Committee and Bylaws to the Hospitals Governing Board.
- Develops and coordinates Focused Professional Practice Evaluation (FPPE) and Ongoing Professional Practice Evaluation (OPPE) processes used to access Medical Staff and Allied Health Professional Staff competency and compliance with AHC, Medical Staff and all other regulatory standards.
- Develops and revises Medical Staff Forms, Manuals and Policies including delineation of privileges, department/section rules and regulations, privileging criteria and other documents as well as Medical Staff Bylaws, Medical Staff Rules and Regulations and Credentials Manuals while ensuring regulatory compliance.
- Provides delegated credentialing services for the Adventist Health Care Managed Care Department for a variety of organizations, including IPA, PHOs, and health plans while ensuring NCQA and URAQ regulations
- Oversees the Undergraduate Medical Education Program for processing and registration of Medical and PA Students, Residents and Fellows.
- Oversees Maryland Department of Health electronic death certificate training and access, Federal Drug Enforcement Agency electronic prescribing of narcotics, and Maryland Board of Physicians fingerprinting and background check processes.
- Ensures Cerner & HIPPA training and compliance of EMR access process for all Physician Office Staff, Billers and Insurance Reviewers as well as deactivation of access including Medical and Allied Health Professional Staff.
- Oversees the Annual and Ongoing Requirements as well as submission of all Trainings and Documents, i.e. Flu, PPD, Computer and Classroom trainings for the Medical Staff and Allied Health Professional Staff.
- Assumes other duties and responsibilities that are related and appropriate to the position and area.The above responsibilities are a general description of the level and nature of the work assigned to this classification and are not to be considered as all-inclusive.
Qualified Candidates will possess:
- Bachelors degree in Business Administration or a HealthCare Administration is required
- Ten (10) years experience in Medical Staff Services required
- Minimum of five years progressive experience in Medical Staff management, credentialing, and privileging with a significant part of that serving as the primary point of contact for regulatory surveys required
- CPCS (Certified Provider of Credentialing Services) Certification by the National Association of Medical Staff Services required
- CPMSM (Certified Professional of Medical Staff Management) Certification by the National Association of Medical Staff Services required
- Certified in Business Project Management preferred
Knowledge of regulatory agency requirements for medical staff, credentialing and privileging required
COVID-19 Vaccination:
Howard University Hospital requires all external applicants to be fully vaccinated for COVID-19 before commencing employment. External Applicants may be required to furnish proof of vaccination and, if offered, may elect to be vaccinated at a designated Howard University Hospital location.
Medical Director, Clinical Services
Posted 9 days ago
Job Viewed
Job Description
Company :
Highmark Inc.
Job Description :
JOB SUMMARY
This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and most current clinical standards. The incumbent reviews escalated cases electronically and using Medical Policy criteria sets to evaluate the medical necessity and appropriateness of the requested treatment of service. Depending on the nature of the case, telephonic peer to peer discussions may be required. The incumbent ensures compliance to NCQA, URAC, CMS, DOH, and DOL regulations at all times. In addition to utilization review, the incumbent participates as the physician member of the multidisciplinary team for case and disease management. They will advise the multidisciplinary team on cases, particularly high-risk cases, through the team structure. Additionally, the incumbent may be assigned special projects to help support and improve the care of our members
ESSENTIAL RESPONSIBILITIES
-
Conduct electronic review of escalated cases against medical policy criteria, which may include telephonic peer to peer discussions, to determine medical necessity and appropriateness. Complete initial determination of cases, review of appeals and grievances, and other reviews as assigned. Compose clear and concise rationales for member and provider determination notifications all while adhering to required compliance standards (NCQA, URAC, CMS, DOH, and DOL regulations, etc.). Ensure that all aspects of the medical management process are consistent with community standards of care.
-
Participate as a member of the CMDM multidisciplinary team. Attend huddles and grand rounds. Advise multidisciplinary team on cases that require physician expertise.
-
Participate in protocol and guidelines development to ensure consistency in the review process.
-
Actively manage projects and/or participate on project teams that require a physician subject matter expert.
-
Other duties as assigned.
EDUCATION
Required
- Medical Doctor (MD) or Doctor of Osteopathic Medicine (DO)
Substitutions
- None
Preferred
- Master's Degree in Business Administration/Management or Public Health
EXPERIENCE
Required
- 5 years in Clinical, Direct Patient care (hospital, outpatient, or private practice)
Preferred
- 1 year in Medical Management in a Health Insurance Plan; strong knowledge of managed care industry
LICENSES AND CERTIFICATION
Required
-
Medical Doctor or Doctor of Osteopathic Medicine (DO)
-
Awarded Board Certification at least once in specialty recognized by the American Board of Medical Specialties or the American Osteopathic Association Specialty Certifying Boards
-
Active medical state licensure required. Additional specific state licensure(s) may be required based on business need.
Preferred
- None
SKILLS
-
Critical Thinking
-
Case Management
-
Customer Service
-
Oral & Written Communication Skills
-
Collaboration
-
Listening
-
Telephone Skills
-
General Computer Skills
-
Clinical Software
-
Managed Care
Language (Other than English)
None
Travel Required
0% - 25%
PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS
Position Type
Office-Based
Teaches / trains others regularly
Occasionally
Travel regularly from the office to various work sites or from site-to-site
Rarely
Works primarily out-of-the office selling products/services (sales employees)
Never
Physical work site required
No
Lifting: up to 10 pounds
Constantly
Lifting: 10 to 25 pounds
Rarely
Lifting: 25 to 50 pounds
Rarely
Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.
Compliance Requirement : This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.
As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company's Handbook of Privacy Policies and Practices and Information Security Policy.
Furthermore, it is every employee's responsibility to comply with the company's Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.
Pay Range Minimum:
$170,000.00
Pay Range Maximum:
$352,500.00
Base pay is determined by a variety of factors including a candidate's qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.
We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below.
For accommodation requests, please contact HR Services Online at
California Consumer Privacy Act Employees, Contractors, and Applicants Notice
Req ID: J267780
Medical Director, Clinical Services

Posted 5 days ago
Job Viewed
Job Description
Highmark Inc.
**Job Description :**
**JOB SUMMARY**
This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and most current clinical standards. The incumbent reviews escalated cases electronically and using Medical Policy criteria sets to evaluate the medical necessity and appropriateness of the requested treatment of service. Depending on the nature of the case, telephonic peer to peer discussions may be required. The incumbent ensures compliance to NCQA, URAC, CMS, DOH, and DOL regulations at all times. In addition to utilization review, the incumbent participates as the physician member of the multidisciplinary team for case and disease management. They will advise the multidisciplinary team on cases, particularly high-risk cases, through the team structure. Additionally, the incumbent may be assigned special projects to help support and improve the care of our members
**ESSENTIAL RESPONSIBILITIES**
+ Conduct electronic review of escalated cases against medical policy criteria, which may include telephonic peer to peer discussions, to determine medical necessity and appropriateness. Complete initial determination of cases, review of appeals and grievances, and other reviews as assigned. Compose clear and concise rationales for member and provider determination notifications all while adhering to required compliance standards (NCQA, URAC, CMS, DOH, and DOL regulations, etc.). Ensure that all aspects of the medical management process are consistent with community standards of care.
+ Participate as a member of the CMDM multidisciplinary team. Attend huddles and grand rounds. Advise multidisciplinary team on cases that require physician expertise.
+ Participate in protocol and guidelines development to ensure consistency in the review process.
+ Actively manage projects and/or participate on project teams that require a physician subject matter expert.
+ Other duties as assigned.
**EDUCATION**
**Required**
+ Medical Doctor (MD) or Doctor of Osteopathic Medicine (DO)
**Substitutions**
+ None
**Preferred**
+ Master's Degree in Business Administration/Management or Public Health
**EXPERIENCE**
**Required**
+ 5 years in Clinical, Direct Patient care (hospital, outpatient, or private practice)
**Preferred**
+ 1 year in Medical Management in a Health Insurance Plan; strong knowledge of managed care industry
**LICENSES AND CERTIFICATION**
**Required**
+ Medical Doctor or Doctor of Osteopathic Medicine (DO)
+ Awarded Board Certification at least once in specialty recognized by the American Board of Medical Specialties or the American Osteopathic Association Specialty Certifying Boards
+ Active medical state licensure required. Additional specific state licensure(s) may be required based on business need.
**Preferred**
+ None
**SKILLS**
+ Critical Thinking
+ Case Management
+ Customer Service
+ Oral & Written Communication Skills
+ Collaboration
+ Listening
+ Telephone Skills
+ General Computer Skills
+ Clinical Software
+ Managed Care
**Language (Other than English)**
None
**Travel Required**
0% - 25%
**PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS**
Position Type
Office-Based
Teaches / trains others regularly
Occasionally
Travel regularly from the office to various work sites or from site-to-site
Rarely
Works primarily out-of-the office selling products/services (sales employees)
Never
Physical work site required
No
Lifting: up to 10 pounds
Constantly
Lifting: 10 to 25 pounds
Rarely
Lifting: 25 to 50 pounds
Rarely
**_Disclaimer:_** _The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job._
**_Compliance Requirement_** _: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies._
_As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company's Handbook of Privacy Policies and Practices and Information Security Policy._
_Furthermore, it is every employee's responsibility to comply with the company's Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements._
**Pay Range Minimum:**
$170,000.00
**Pay Range Maximum:**
$352,500.00
_Base pay is determined by a variety of factors including a candidate's qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets._
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.
We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below.
For accommodation requests, please contact HR Services Online at
California Consumer Privacy Act Employees, Contractors, and Applicants Notice
Req ID: J267780
Automation Tester with Healthcare Provider Configuration
Posted today
Job Viewed
Job Description
Location:
The role of Automation Tester with Healthcare Provider Configuration is pivotal in ensuring the seamless integration and functionality of our healthcare solutions.
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Business transformation, Healthcare Provider Operations -Senior
Posted 10 days ago
Job Viewed
Job Description
Location: Anywhere in Country
At EY, we're all in to shape your future with confidence.
We'll help you succeed in a globally connected powerhouse of diverse teams and take your career wherever you want it to go. Join EY and help to build a better working world.
Business transformation, Healthcare Provider Operations_Senior
#Healthcare
About our business
At EY Consulting, we are building a better working world by transforming businesses through the power of people, technology, and innovation. Our clients are at the heart of what we do. We're focused on solving the key issues of our client buyers, building deeper relationships, and generating lasting value with significant impact.
Our firm sets the standard for consulting services, fostering an environment that encourages career ownership at every stage. As a part of our team, you'll be at the forefront of this dynamic service line, driving change and delivering solutions that revolutionize business operations. You'll help our clients in transformation and innovation efforts: driving growth, reducing costs, and managing risks proactively.
Healthcare Consulting
Today's healthcare environment in the post-COVID era is undergoing rapid change and transformation. As healthcare organizations seek to stabilize operations and plan for a financially sustainable future, they are challenged to integrate transformative technology (Artificial intelligence, automation, etc.), adjust to patient-focused operations, and maintain operational discipline to withstand increasing financial pressures. As a manager within our Health consulting practice, you'll work with clients across the healthcare industry, from hospitals and integrated delivery networks to commercial and governmental insurers. You'll use your industry knowledge and relationship skillsets to assist our clients in transforming operations to meet the evolving demands of today's healthcare market.
The opportunity
As a Senior Consultant on our Health team, you will play a key role in helping health systems and health insurance companies tackle their financial and operational challenges. You'll contribute to important projects and work closely within teams, using your skills to turn complex data into clear, actionable insights. The health industry is experiencing an unprecedented surge, and our clients depend on us to steer them through transformative changes and pressing challenges. In this pivotal role, you will elevate client outcomes, improve access to care, support quality of care, and streamline the cost of care. If your drive lies in the healthcare sector and you excel in client-facing situations, this position is tailored for you.
Your key responsibilities
You'll spend most of your time teaming with our provider team working with a broad spectrum of not-for-profit and for-profit healthcare clients, including hospitals, healthcare systems, physician practices and academic medical centers, to assess and redesign clinical processes.
As a Senior in our Health consulting group, you'll work with clients across the following areas:
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Operational improvement
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Benchmarking and financial quantification
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Cost reduction/revenue enhancement
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Workflow redesign
Skills and attributes for success
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Effectively manage and motivate client engagement teams with diverse skills and backgrounds Foster an innovative and inclusive team -oriented work environment. Play an active role in counselling and mentoring junior consultants within the organization
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Foster relationships with client personnel at appropriate levels. Consistently deliver quality client services. Drive high-quality work products within expected timeframes and on budget. Monitor progress, manage risk and ensure key stakeholders are kept informed about progress and expected outcomes
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Cultivate and manage business development opportunities. Understand EY and its service lines and actively assess/present ways to serve clients. Develop and maintain long-term client relationships and networks
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Demonstrate in-depth technical capabilities and professional knowledge
Required qualifications
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A bachelor's or master's degree and approximately 3+ years of relevant work experience in healthcare, insurance, business analysis, consulting, or a related field.
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Approximately 2 years of healthcare consulting experience, preferably with prior experience in a consulting firm
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Assist in generating revenue within existing healthcare clients and in developing new prospects at the "C" level of large healthcare companies
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Ability to manage a team of staff/senior consulting professionals
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Ability to work collaboratively in a team environment (knows when to lead and when to follow)
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Strong analytical and problem-solving skills, as well as excellent oral and written communication skills
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A willingness to travel to meet client needs; travel is required as needed by the client.
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Strong leadership skills and the ability to work collaboratively in a team environment, demonstrate inclusivity, and embrace diverse perspectives.
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Excellent presentation skills and the ability to communicate complex concepts effectively to all audiences while leveraging relevant data to generate insights and innovative solutions.
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Intellectual curiosity, the ability to take initiative and drive execution, and advanced analytical and problem-solving skills within a dynamic and evolving business landscape.
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Exhibits an agile and growth-oriented mindset.
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Possesses strong commercial awareness and has a desire to make a positive impact on global companies as well as domestic businesses, contributing to their long-term success.
Preferred qualifications
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Knowledgeable in relevant industry areas such as Health plans, health systems and healthcare specific applications.
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Exposure to operational improvement, benchmarking and financial quantification, cost reduction/revenue enhancement or workflow redesign within the health industry.
What we look for
We're interested in passionate leaders with strong vision and a desire to stay on top of trends in the healthcare industry. If you have a genuine passion for healthcare, this role is for you
What we offer you
At EY, we'll develop you with future-focused skills and equip you with world-class experiences. We'll empower you in a flexible environment, and fuel you and your extraordinary talents in a diverse and inclusive culture of globally connected teams. Learn more .
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We offer a comprehensive compensation and benefits package where you'll be rewarded based on your performance and recognized for the value you bring to the business. The base salary range for this job in all geographic locations in the US is $96,300 to $76,500. The base salary range for New York City Metro Area, Washington State and California (excluding Sacramento) is 115,500 to 200,600. Individual salaries within those ranges are determined through a wide variety of factors including but not limited to education, experience, knowledge, skills and geography. In addition, our Total Rewards package includes medical and dental coverage, pension and 401(k) plans, and a wide range of paid time off options.
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Join us in our team-led and leader-enabled hybrid model. Our expectation is for most people in external, client serving roles to work together in person 40-60% of the time over the course of an engagement, project or year.
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Under our flexible vacation policy, you'll decide how much vacation time you need based on your own personal circumstances. You'll also be granted time off for designated EY Paid Holidays, Winter/Summer breaks, Personal/Family Care, and other leaves of absence when needed to support your physical, financial, and emotional well-being.
Are you ready to shape your future with confidence? Apply today.
EY accepts applications for this position on an on-going basis.
For those living in California, please click here for additional information.
EY focuses on high-ethical standards and integrity among its employees and expects all candidates to demonstrate these qualities.
EY | Building a better working world
EY is building a better working world by creating new value for clients, people, society and the planet, while building trust in capital markets.
Enabled by data, AI and advanced technology, EY teams help clients shape the future with confidence and develop answers for the most pressing issues of today and tomorrow.
EY teams work across a full spectrum of services in assurance, consulting, tax, strategy and transactions. Fueled by sector insights, a globally connected, multi-disciplinary network and diverse ecosystem partners, EY teams can provide services in more than 150 countries and territories.
EY provides equal employment opportunities to applicants and employees without regard to race, color, religion, age, sex, sexual orientation, gender identity/expression, pregnancy, genetic information, national origin, protected veteran status, disability status, or any other legally protected basis, including arrest and conviction records, in accordance with applicable law?
EY is committed to providing reasonable accommodation to qualified individuals with disabilities including veterans with disabilities. If you have a disability and either need assistance applying online or need to request an accommodation during any part of the application process, please call 1-800-EY-HELP3, select Option 2 for candidate related inquiries, then select Option 1 for candidate queries and finally select Option 2 for candidates with an inquiry which will route you to EY's Talent Shared Services Team (TSS) or email the TSS at .
Consulting Director – Innosight Healthcare Provider Strategy & Innovation (Nationwide) (Washington)
Posted today
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Job Description
Innosight is a global strategy consulting firm focused on helping leading organizations design and create the future. We work with them to develop growth strategies, build innovation capabilities, and accelerate new growth initiatives. As a member of the Innosight team, youll have the opportunity to work with leaders at Global 1000 companies to tackle some of the most interesting challenges in business.
Our Focus and Values- We are the leading practitioners of disruptive innovation, building on the work of our co-founder, Harvard Business School professor Clay Christensen.
- We focus on growth strategy and innovation, bringing unique expertise and authority to our clients challenges: identifying opportunities, building innovative organizations, and disrupting ourselves before others do.
- Our core values include humility, collaboration, transparency, and intellectual curiosity, guiding our work and commitment to organizational innovation.
- Our work environment promotes idea exchange, continuous learning, and collaboration, with a smaller team structure that offers early exposure to senior executives.
Healthcare organizations must stay ahead of disruption by making data-driven decisions that accelerate transformation. Innosight examines patient care challenges faced by payor and provider entities to stabilize current business and create future growth engines. We partner with CEOs and C-Suite executives to design innovative enterprise-level strategies and partnerships for leading healthcare organizations.
Role: DirectorThis is a high-responsibility, high-impact role requiring leadership and problem-solving skills. The Director will liaise with internal senior leadership and manage day-to-day client relationships to ensure project success and impact.
Required Experience- Extensive consulting experience with a top management consulting firm, especially in healthcare strategy.
- Proven success leading strategic planning, growth strategies, M&A, alliances, and cost strategies within healthcare provider organizations.
- Deep industry knowledge of healthcare providers, including hospitals, academic centers, and physician groups.
- Strong analytical, strategic, and problem-solving skills, with the ability to handle large data sets and make high-quality decisions.
- Experience managing complex projects, leading teams, and delivering high-quality client outcomes.
- Excellent communication skills, capable of crafting impactful proposals, presentations, and workshops, and coaching teams effectively.
- Talent development skills, with a track record of attracting, coaching, and advancing talented professionals.
- Alignment with core values: openness, integrity, diversity, and a client-focused approach.
- Willingness to travel up to 80% weekly; location flexible within the contiguous US near a major airport.
The estimated base salary range is $215,000 - $50,000. Including annual incentives, total compensation is estimated at 311,750 - 362,500. Benefits include medical, dental, vision, and wellness programs.
#LI-JD1 #LI-Remote
Position Level: DirectorCountry: United States of America #J-18808-Ljbffr
Medical Professional (EMT-P/ EMT-I/ EMT-A/ LPN)
Posted today
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Job Description
Looking to strengthen your positive impact on patients' lives, your level of excitement at work, and your compensation? We thrive on change. (So can you!) The role of an EMT/Paramedic at Octapharma Plasma is rewarding in every sense of the word. No two days are the same as every situation brings exciting new challengesones we meet with genuine empathy, skill, and enthusiasm. Our rapidly expanding organization offers the ability to enhance lives, exhilarating work, and the compensation you deserve. Join us as a:
EMT/PARAMEDIC/LPN PHYSICIAN SUBSTITUTE/MEDICAL PROFESSIONAL
Essential Job FunctionsEvaluates Donor Eligibility + Determines donor eligibility of new and return donors for plasmapheresis procedures and immunizations by conducting evaluations to ensure criteria of plasma donors are met and in accordance with SOPs, FDA, CLIA, and cGMP.
Reviews informed consent forms for plasmapheresis and immunization. Includes explanation of procedures, potential adverse events, immunization schedules, possible antibody formation, and dose administration. Offering clear opportunity for donor to refuse participation.
Performs medical history reviews and health assessments for donors.
Maintains accurate and up-to-date Physician Communication Logs, in accordance with SOP.
Understands and utilizes donor center's donor management system (NexLynk). Maintains Donor Center Compliance.
Uses SOPs to facilitate compliance with regulations.
Complies with federal, state, local, and company-specific regulations related to quality of product, employee and donor safety, and the proper performance of day-to-day activities.
Reviews donor management system (NexLynk) and/or immunization paperwork to ensure accuracy and completeness.
Manages Donors.
Reviews accumulated data in a timely fashion to confirm eligibility and consults with donor center Licensed Physician, as needed.
Classifies donors to appropriate program.
Monitors donor reactions to plasmapheresis and documents accordingly.
Provides appropriate medical care per SOP to donors if complications arise.
Interacts with donor center Licensed Physician regarding ordering immunizations.
Performs duties for the Hyperimmune Program, if applicable, as described in SOPs.
Reviews all normal and abnormal test results in donor management system (Nexlynk) to determine continued donor eligibility.
Cannot reinstate donors who have been deferred due to an abnormal Serum Protein Electrophoresis (SPE).
May not evaluate high-risk/known infectious donors.
May only determine the continued eligibility for plasmapheresis of normal, healthy donors.
Ensures confidentiality of employee, donor, and donor center records while performing all duties.
Counsels donors with abnormal test results or eligibility concerns and defers them according to the donor deferral matrix. Refers donors to appropriate county/state health department or similar for follow-up and diagnostic testing, when applicable per SOP.
Additional Responsibilities:
Train as a Donor Center Technician I, as outlined in the Donor Center Technician I job description. Acknowledgment and signature of the job description are required. Note: This requirement does not apply to exempt managers acting as Emergency MP's.
Upon completion of initial training in your functional area, and where applicable:
Responsible for mentoring and training Medical Professionals, able to drive training efficiencies to ensure timeliness and compliance as a Designated Trainer.
Train as a QA Backup and perform related duties as required by business needs.
Performs other job-related tasks as assigned.
Job SpecificationsGraduate of a recognized healthcare-related educational program, such as Physician, Nurse (Licensed Practical Nurse or Registered Nurse). Certified/licensed as an emergency medical technician (EMT Basic, EMT 2-intermediate, or 3- advanced/paramedic, if allowable).
Must work within the scope of the professional license/certification, as defined by the state in which the work is performed.
Any specific state licensing requirements must be met per location.
Alabama: Must always have a Licensed Practical Nurse or Registered Nurse on staff during plasmapheresis to supervise processes and procedures, but not staff, of the medical screening and/or donor floor areas, per state regulation.
California: Must be Registered Nurse and be currently licensed in the state. Must be able to supervise processes and procedures, but not staff, of the medical screening and/or donor floor areas, per state regulation.
New Jersey: Must be a Licensed Practical Nurse or Registered Nurse. Must always have a Registered Nurse or a Licensed Practical Nurse on staff during plasmapheresis to provide emergency care, per blood bank state regulation.
Ohio: Must be an EMT-Intermediate, EMT-Paramedic, Licensed Vocational Nurse, Licensed Practical Nurse, or Registered Nurse. Must have at least one (1) RN, LPN, LVN, EMT-P, or EMT-I always present in the Donor Center during plasmapheresis to supervise processes and procedures, but not staff, of the donor floor area, per state regulation.
Washington: Must be a Licensed Practical Nurse or Registered Nurse. Must always have a Registered Nurse on staff during plasmapheresis to supervise processes and procedures, but not staff, of the medical screening and/or donor floor areas, per state regulation.
One (1)-year experience in the hospital, field care, or experience in a plasma center preferred.
Everyone performing moderate complexity testing must possess a current license issued by the state where the donor center is located, based on any required state regulations.
Must successfully complete training program and competency assessments using OPIapproved training modules or training curriculum.
Must have excellent patient/donor assessment skills.
Must be able to manage emergency situations in accordance with standard medical care practices.
Maintain current and valid license and pass medical credential evaluation.
Must maintain current cardiopulmonary resuscitation (CPR) certification.
Must be highly organized and have attention to detail.
Possess effective physical and clinical assessment skills customer service, and people management skills.
Ability to understand and follow SOPs and protocols.
Must possess basic computer knowledge and skills. Basic working knowledge of Microsoft Word and Excel preferred.
Must be able to speak, read, write, and understand English.
Demonstrate consistency and reliability (good attendance, punctuality, full effort throughout shift, flexibility with assigned schedule).
Ability to work shifts consisting of day and evening hours, weekends, holidays and extended shifts on a frequent basis.
Physical RequirementsAbility to sit or stand for extended periods.
Always utilize all required and appropriate PPE (Personal Protective Equipment).
Ability to tug, lift, and pull up to thirty-five pounds.
Ability to bend, stoop, or kneel.
Ability to perform precise tasks that require repetitive small motor skills, such as drawing blood for screening tests.
Occupational exposure to blood-borne pathogens.
Ability to view video display terminal less than 18" away from face for extended periods of time, up to four (4) hours at a time.
Enter an environment with a temperature of -40C or colder according to Standard Operating Procedures.
Occasional exposure to and handling of dry ice.
Ability to use assistive devices if needed for mobility or communication.
Physical ability to perform CPR and sufficient mobility to immediately assist in treatment of any adverse donor reactions.