43 Medical Assistants jobs in Aibonito

**Your Future Evolves Here**
Evolent partners with health plans and providers to achieve better outcomes for people with most complex and costly health conditions. Working across specialties and primary care, we seek to connect the pieces of fragmented health care system and ensure people get the same level of care and compassion we would want for our loved ones.
Evolent employees enjoy work/life balance, the flexibility to suit their work to their lives, and autonomy they need to get things done. We believe that people do their best work when they're supported to live their best lives, and when they feel welcome to bring their whole selves to work. That's one reason why diversity and inclusion are core to our business.
Join Evolent for the mission. Stay for the culture.
**What You'll Be Doing:**
What You Will Be Doing:
+ Serve as the Physician match reviewer in Medical Oncology and imaging cases, that do not initially meet the applicable medical necessity guidelines, as well as other imaging requests when providers, clients, or state laws require specialty reviews to be completed by the subject matter expert.
+ Discusses determinations (peer to peer phone calls) with requesting physicians or ordering providers, when available, within the regulatory timeframe of the request and provides clinical rationale for standard and expedited appeals.
+ Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD review process to reflect appropriate utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance (NCQA) guidelines.
+ Aids and acts as a resource to Initial Clinical Reviewers.
+ Ensures documentation of all communications with medical office staff and/or MD provider is recorded in a timely and accurate manner.
+ May assist the Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support.
+ Participates in on-going training per inter-rater reliability process.
Qualifications-
+ MD/DO/MBBS
+ Minimum of five (5) years' experience in the practice of Medicine, post residency and Active Clinical practice within the last 2 years is preferred
+ Current, unrestricted clinical license in medicine or required specialty-
+ Obtaining and maintaining medical licenses in the state you reside, as well as any license required per business needs
+ Active Board Certification in Medical Oncology
+ Strong clinical, management, communication, and organizational skills
+ Energetic and curious with a passion for quality and value in health care
+ Computer Proficiency
+ Not under current exclusion or sanction by any state or federal health care program, including Medicare or Medicaid, and is not identified as an "excluded person" by the Office of Inspector General of the Department of Health and Human Services or the General Service Administration (GSA), or reprimanded or sanctioned by Medicare.
+ No history of a major disciplinary or legal action by a state medical board
To ensure a secure hiring process we have implemented several identity verification steps, including submission of a government issued photo ID. We conduct identity verification during interviews, and final interviews may require onsite attendance. All candidates must complete a comprehensive background check, in-person I-9 verification, and may be subject to drug screening prior to employment. The use of artificial intelligence tools during interviews is prohibited and monitored. Misrepresentation will result in immediate disqualification from consideration.
**Technical Requirements:**
We require that all employees have the following technical capability at their home: High speed internet over 10 Mbps and, specifically for all call center employees, the ability to plug in directly to the home internet router. These at-home technical requirements are subject to change with any scheduled re-opening of our office locations.
**Evolent is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, or disability status.** **If you need reasonable accommodation to access the information provided on this website, please contact** ** ** **for further assistance.**
The expected base salary/wage range for this position is $120-130/hr. This position is also eligible for a bonus component that would be dependent on pre-defined performance factors. As part of our total compensation package, Evolent is proud to offer comprehensive benefits (including health insurance benefits) to qualifying employees. All compensation determinations are based on the skills and experience required for the position and commensurate with experience of selected individuals, which may vary above and below the stated amounts.
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ELIGIBLE FOR UP TO A $22.5K SIGNING BONUS. Talk to your recruiter for details. As a Patriot System Repairer, you’ll become one of the most highly trained Soldiers in the world. You’ll use your advanced skills to perform field-level maintenance on the Patriot missile system, one of the world’s most sophisticated air defense systems. Your responsibilities will include diagnosing issues, performing tests, and making necessary repairs on specific components. Requirements U.S. Citizen Age: 17-34 years High School Diploma or GED Must meet tattoo guidelines No major law violations No significant medical concerns Training & Certifications 34 Nationally Recognized Certifications Available 10 weeks of Basic Training 45 weeks of Advanced Individual Training 107 ASVAB Score: Electronics (EL) OR 102 ASVAB Score: Electronics (EL) 90 ASVAB Score: Skilled Technical (ST) Skills You'll Learn Electronic Troubleshooting Maintenance & Repairs Diagrams & Schematics

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

**Become a part of our caring community and help us put health first**
The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing home health, SNF, DME, dual Medicare/Medicaid and Waiver requests. The Medical Director provides medical interpretation and determinations whether services provided by other healthcare professionals are in agreement with national guidelines, CMS requirements, Humana policies, clinical standards, and (in some cases) contracts.
The Medical Director provides medical interpretation and decisions about the appropriateness of services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards. All work occurs with a context of regulatory compliance, and work is assisted by diverse resources which may include national clinical guidelines, CMS policies and determinations, clinical reference materials, internal teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and Medicare Advantage requirements, and will understand how to operationalize this knowledge in their daily work. The Medical Director works in a structured environment with expectations for consistency in thinking, authorship, meeting departmental expectations, and compliance timelines.
**Use your skills to make an impact**
Required Qualifications
+ MD or DO degree
+ Current and ongoing board certification in an approved ABMS Medical Specialty
+ A current and unrestricted license in at least one jurisdiction and willing to obtain license, as required, for various states in region of assignment
+ 5+ years of direct clinical patient care experience post residency or fellowship
+ No sanctions from Federal or State Governmental organizations
+ The ability to pass credentialing requirements
+ Excellent verbal and written communication skills with analytic and interpretative skills
+ Participate in educational activities by attending required conferences and also create content to lead/teach/present for individual subject matter contribution
Preferred Qualifications
+ Experience in an inpatient environment and/or related to care of a Medicare type population (disabled or >65 years of age)
+ Internal Medicine, Family Practice, Geriatrics, Physiatry, Emergency Medicine, Critical Care or hospital based clinical specialists
+ Ability to function in a dynamic fast paced environment
+ Commitment to a culture of innovation
+ Passionate about contributing to an organization's focus on consistency in outcomes, consumer experiences, and a highly engaged team culture
+ Knowledge and experience with national guidelines such as NCD/LCD, MCG® or InterQual
The Medical Director conducts clinical case reviews of requests received by members of the Medicare population and reports to the Lead Medical Director.
**Other duties:**
+ Identify medical management operational improvements, including those within the medical director area
+ Participate in call rotation which may include weekend coverage
+ Develop collaborative relationships with Team and key partners within the Medicare Line of Business.
+ Support Home Solutions as needed
+ Other activities as assigned by the managing Medical Director
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
**Scheduled Weekly Hours**
40
**Pay Range**
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$223,800 - $313,100 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
**Description of Benefits**
Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
Application Deadline:
**About us**
Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.
**Equal Opportunity Employer**
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our

When you join the team at Unum, you become part of an organization committed to helping you thrive.
Here, we work to provide the employee benefits and service solutions that enable employees at our client companies to thrive throughout life's moments. And this starts with ensuring that every one of our team members enjoys opportunities to succeed both professionally and personally. To enable this, we provide:
+ Award-winning culture
+ Inclusion and diversity as a priority
+ Performance Based Incentive Plans
+ Competitive benefits package that includes: Health, Vision, Dental, Short & Long-Term Disability
+ Generous PTO (including paid time to volunteer!)
+ Up to 9.5% 401(k) employer contribution
+ Mental health support
+ Career advancement opportunities
+ Student loan repayment options
+ Tuition reimbursement
+ Flexible work environments
**_*All the benefits listed above are subject to the terms of their individual Plans_** **.**
And that's just the beginning.
With 10,000 employees helping more than 39 million people worldwide, every role at Unum is meaningful and impacts the lives of our customers. Whether you're directly supporting a growing family, or developing online tools to help navigate a difficult loss, customers are counting on the combined talents of our entire team. Help us help others, and join Team Unum today!
**General Summary:**
Unum is expanding its team of skilled Physicians focusing on Internal Medicine, Family Practice, Occupational Medicine, and Physical Medicine and Rehabilitation.
This position is responsible for providing expert medical analysis of claims files (or underwriting applications) across Unum US product lines. The incumbent provides high quality, timely, and efficient medical consultative services to the Benefits Center. The Medical Consultant adheres to current regulatory, claim process, and internal workflow standards as set forth in the Benefits Center Claims Manual, underwriting manual, and associated documentation. The incumbent adheres to accepted norms of medical practices and Code of Conduct guidelines. Physicians and psychologists conduct their reviews and analyses within appropriate ethical standards and maintain their professional licenses and Board certifications. This role is expected to provide excellent customer service and to interact on a regular basis with business partners, health care providers, and other specialized resources.
**Principal Duties and Responsibilities**
+ Provide timely, clear medical direction and opinions to team partners, with reasoned forensic analysis to support the medical opinions
+ Partner/consult with fellow medical consultants when appropriate to ensure the completion of a whole person analysis
+ Apply medical knowledge to determine functional capacity through assessment of medical and other data related to impairment, regarding accuracy of diagnoses, treatment plans, duration guidelines, and prognosis
+ Provide relevant medical education and knowledge to others in terms appropriate and understandable to the intended audience
+ Perform telephone contacts with the insured's healthcare providers to gather medical information and to facilitate a better understanding of the claimant's functional abilities
+ Make timely and appropriate referrals for second opinion reviews when appropriate or required according to current guidelines and best practices
+ Demonstrate ability to manage and complete high volumes of assigned work, maintain consistently good turnaround times, and operate with a sense of urgency
+ Focus not only on individual workload, but on the team/group work volumes to ensure organizational success
+ Receive feedback and follow through with appropriate behaviors/actions
+ Perform other duties as assigned
**Job Specifications**
+ Professional Degree (MD, DO, PhD, PsyD)
+ Active, unrestricted US medical license
+ Board certification required for physicians in their area of specialty
+ Minimum of five years of clinical experience in medical specialty
+ Strong team and collaborative skills. Ability to work in a fast paced, team based, corporate environment
+ Ability to mentor others and to give and receive constructive, behaviorally based feedback with peers and partners
#IN1
#LI-RA1
Unum and Colonial Life are part of Unum Group, a Fortune 500 company and leading provider of employee benefits to companies worldwide. Headquartered in Chattanooga, TN, with international offices in Ireland, Poland and the UK, Unum also has significant operations in Portland, ME, and Baton Rouge, LA - plus over 35 US field offices. Colonial Life is headquartered in Columbia, SC, with over 40 field offices nationwide.
Unum is an equal opportunity employer, considering all qualified applicants and employees for hiring, placement, and advancement, without regard to a person's race, color, religion, national origin, age, genetic information, military status, gender, sexual orientation, gender identity or expression, disability, or protected veteran status.
The base salary range for applicants for this position is listed below. Unless actual salary is indicated above in the job description, actual pay will be based on skill, geographical location and experience.
$133,500.00-$274,100.00
Additionally, Unum offers a portfolio of benefits and rewards that are competitive and comprehensive including healthcare benefits (health, vision, dental), insurance benefits (short & long-term disability), performance-based incentive plans, paid time off, and a 401(k) retirement plan with an employer match up to 5% and an additional 4.5% contribution whether you contribute to the plan or not. All benefits are subject to the terms and conditions of individual Plans.
Company:
Unum

**Company Overview:**
Otsuka is a global healthcare company driven by our purpose "to defy limitation, so
that others can too." Patients are at the center of our purpose as we seek to discover and deliver innovative healthcare solutions. Otsuka is a leader in the CNS therapeutic area (TA), which is comprised
of a strong portfolio of individual development and marketed assets. As we continue to develop innovative medicines for those with CNS disorders, we are seeking a skilled and experienced Medical Director of CNS Early Assets, Global Medical Affairs, responsible for certain assets within the broader CNS TA portfolio Medical Affairs (both US and Global), with a specialization in Psychiatry and/or Neurology. Accountable for a subset of assigned assets within the CNS TA which align to the broader overall TA strategy determined by the Sr. Director, Franchise Lead CNS Early Assets.
**Position Summary:**
The Medical Director, Global Medical Affairs, CNS Early Assets will be responsible for supporting and executing the strategic vision for a select group of assigned assets within our CNS TA (encompassing Psychiatry and emerging Neurology portfolio). This role will report to the Sr. Director, Global Medical Affairs, Franchise Lead CNS Early Assets. Assets under this person's responsibilities may include treatments for several serious illnesses with unmet needs in various stages of early development. This role will involve collaborating with cross-functional teams, key opinion leaders (KOLs), and stakeholders to ensure the successful implementation of asset level medical affairs strategies and tactics, ultimately driving the development and commercialization of treatments in the CNS space. The position consists of both US and Global Medical TA and asset level strategies and plans.
**Key Responsibilities:**
+ Align to the therapeutic strategy, support the strategic vision for the respective assigned assets or TA portfolio.
+ Contribute to the development and execute the medical strategic plans and initiatives for assigned assets based on unmet needs and medical value proposition that is aligned with and compliments the overall TA strategy.
+ May represent Medical Affairs at certain US and Global governance meetings. The Director will work closely with other US and Global franchise or asset specific cross functional leads and will pull through the CNS TA strategy.
+ Ensure insights into and contribute to the development and optimization of TRPPs (target reimbursable product profiles) for any assigned assets in development.
+ Support lifecycle management initiatives and planning for assigned assets as applicable.
+ Stakeholder engagement: Establish and maintain strong relationships with key opinion leaders, academic institutions, and medical/advocacy societies within the assigned disease areas within the CNS TA.
+ Act as a company representative and advocate in relevant medical and scientific communities for specific assigned areas within the TA.
+ Engages with a network of international scientific leaders and other key stakeholders (therapeutic guideline committees, payers, public groups, government officials, medical societies) about Our Company's emerging science.
+ Ensure peer relations within Otsuka across functions at appropriate leadership levels (Clin Dev, Translational Medicine, Global and US Marketing, Global Value and Real-World Evidence, etc.).
+ Scientific and Medical Affairs Expertise: Experienced in US and global healthcare landscape for assigned areas. Knowledge and strong competency with the US healthcare system and regulatory landscape is required for this role.
+ Stay abreast of the latest advancements, research, and publications within the assigned disease areas in psychiatry and neurology. Act as a subject matter expert, providing medical and scientific insights to internal teams and external stakeholders.
+ Be up to date on latest evolutions in Medical Affairs trends and help franchise and department to continuously adapt and stay ahead.
+ Cross-Functional Collaboration: Collaborate closely with other key functions, including regional medical leads, clinical development, global value and real-world evidence, US and global commercial teams, market access, and regulatory affairs, to ensure integrated global strategies and cohesive medical affairs strategies and input into cross functional leadership meetings and plans.
**Requirements:**
+ Medical Doctor (MD), PhD or PharmD candidates with demonstrated experience in CNS Psychiatry or Neurology (preferably neuroinflammatory) conditions.
+ Must have US Medical Affairs experience in addition to Global Medical Affairs experience (preferred) and knowledge of applicable US regulations.
+ Relevant experience in translational medicine (T0 - T1) or early development (phase 1) assets either within Medical Affairs, Regulatory Affairs, or Clinical Development is preferred.
+ Minimum of 7+ years of relevant experience in the pharmaceutical industry or biotechnology setting. Product launch experience preferred, especially in US.
+ Clinical or academic practice in CNS preferred.
+ Strategic mindset with the ability to translate insights into actionable plans.
+ Strong communication and presentation skills, with the ability to interact effectively with internal and external stakeholders, including KOLs.
+ Ability to work in a fast-paced, dynamic environment, with a proactive and problem-solving mindset.
**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 $205,368.00 - Maximum $307,050.00, plus incentive opportunity: The range shown represents a typical pay range or starting pay for individuals who are hired in the role to perform in the United States. Other elements may be used to determine actual pay such as the candidate's job experience, specific skills, and comparison to internal incumbents currently in role. Typically, actual pay will be positioned within the established range, rather than at its minimum or maximum. This information is provided to applicants in accordance with states and local laws.
**Application Deadline** : This will be posted for a minimum of 5 business days.
**Company benefits:** Comprehensive medical, dental, vision, prescription drug coverage, company provided basic life, accidental death & dismemberment, short-term and long-term disability insurance, tuition reimbursement, student loan assistance, a generous 401(k) match, flexible time off, paid holidays, and paid leave programs as well as other company provided benefits.
Come discover more about Otsuka and our benefit offerings; .
**Disclaimer:**
This job description is intended to describe the general nature and level of the work being performed by the people assigned to this position. It is not intended to include every job duty and responsibility specific to the position. Otsuka reserves the right to amend and change responsibilities to meet business and organizational needs as necessary.
Otsuka is an equal opportunity employer. All qualified applicants are encouraged to apply and will be given consideration for employment without regard to race, color, sex, gender identity or gender expression, sexual orientation, age, disability, religion, national origin, veteran status, marital status, or any other legally protected characteristic.
If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation, if you are unable or limited in your ability to apply to this job opening as a result of your disability. You can request reasonable accommodations by contacting Accommodation Request ( ) .
**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.

**Position Overview**
We are hiring a Senior Counsel to be an integral part of the legal team providing support to the Medical Device businesses of FUJIFILM Healthcare Americas Corporation and FUJIFILM SonoSite, Inc., wholly-owned subsidiaries of FUJIFILM Holdings America Corporation (HLUS). The Senior Counsel, reporting to the Division General Counsel, Medical Devices, will be an experienced commercial transactions lawyer, responsible for working independently and collaboratively on legal issues affecting the Medical Device businesses to minimize risks of legal liability and ensure maximum legal rights of the company. The right candidate will be excited to join a growing company with a diverse portfolio of businesses. This attorney will be a senior legal resource and valued business partner for HLUS and its Medical Device businesses.
Please include cover letter and resume indicating your interest and expertise in this position.
**Company Overview**
At FUJIFILM Holdings America Corporation, we're redefining innovation across the industries we touch-from healthcare and photography to semiconductors and data storage. With roots in photosensitive materials and a legacy of groundbreaking technology, we now lead 23 diverse affiliate businesses across the Americas.
We're looking for mission-driven talents eager to join us to help create, market, and support a vast portfolio of products. At Fujifilm you'll have the opportunity to explore and grow your skills in new, exciting ways. Whether you're shaping tomorrow's tech or redefining today's processes, we'll provide a flexible work environment and dynamic culture where innovation thrives.
Our Americas HQ is nestled in Valhalla, New York, a charming town known for its excellent schools, beautiful parks, and easy access to the vibrancy of New York City.
Fujifilm is globally headquartered in Tokyo with over 70,000 employees across four key business segments of healthcare, electronics, business innovation, and imaging. We are guided and united by our Group Purpose of "giving our world more smiles." Visit: Description**
**Responsibilities**
+ Manage and support the day-to-day legal affairs of assigned Medical Device businesses or operating divisions, under the general supervision of, and in consultation and collaboration with, the Division General Counsel.
+ Manage outside counsel supporting designated Medical Device businesses and operating divisions as assigned by the Division General Counsel.
+ Coordinate and provide strategic legal advice to business partners with respect to a variety of legal matters affecting the Medical Device businesses, including commercial contracts, advertising and marketing, competitor interactions, and other matters.
+ Draft, review and negotiate a variety of complex commercial contracts, including customer, distributor and vendor agreements; development, manufacturing and service agreements; clinical trial agreements; group purchasing agreements; and distributor agreements, among others. Work with internal colleagues and outside counsel on a regular basis to review and handle a large volume of contracts, to ensure agreements mitigate legal risk and support business objectives.
+ Advise, counsel and report to Division General Counsel and senior business management on general legal and regulatory risks affecting the Medical Device businesses, including with respect to healthcare regulatory compliance, anti-kickback statutes, the False Claims Act, U.S. government programs and contracting compliance requirements, antitrust laws, and other applicable laws.
+ Keep abreast of legislative and regulatory changes with respect to healthcare and other relevant regulations that may affect HLUS' Medical Device businesses.
+ Provide training to HLUS' Medical Device businesses on substantive legal topics relevant to healthcare regulatory compliance, as assigned by Division General Counsel.
+ Contribute to, and help drive, the Legal Department's commitment to continuous operational improvement and achievement of efficiency, consistency, and alignment of contracting practices and best-in-class contract terms across the Legal Department and the HLUS Group organization to support the evolving needs and growth and expansion of HLUS Group companies.
+ Perform other duties as assigned.
**Required Skills/Education**
+ Juris Doctor from accredited law school. Academic honors preferred.
+ Admitted to practice law and in good standing under the Bar of at least one U.S. state.
+ Minimum 10+ years of relevant legal experience with at least 3 years with an in-house corprorate legal department preferred.
+ **_5+ years recent experience advising medical device, pharmaceutical or life science companies_**
+ Experience with the federal antikickback statue desired
+ Solid commercial contract background with extensive drafting and negotiation experience in fast-paced business environment. Experience in legal matters involving tariffs and other trade compliance issues would be a plus.
+ Strong work ethic and ability to timely, effectively and autonomously manage multiple complex projects, to collaborate with internal and external stakeholders and to drive contracts and other legal projects to completion.
+ Quickly grasps organizational objectives and applies them to commercial contracts or other work product in a way that is succinct and practical.
+ Skill in providing regulatory advice in a complex business environment.
+ Strong ability to produce clear, concise, and professional written work product, including business communications with senior leadership.
+ Adept at partnering across business divisions, functions, and geography, with a skill for engaging resources at all levels in projects and processes while continuing to own and drive them.
+ Ability to manage junior-level counsel, paralegals, or non-attorney administrative staff.
+ Ability to use, or quickly acquire skill necessary for using, legal technology platforms and applications such as Microsoft Office and Microsoft Teams.
+ Maintains professional demeanor, including when working under pressure.
**Desired Skills**
+ Strong organization, communication, and interpersonal skills
+ Ability to complete time-sensitive projects under pressure
+ Analytical ability
+ Proactive and responsive
+ Budget conscious
**Salary and Benefits**
+ Up to $180,000- $190,000 depending on experience.
+ Medical, Dental, Vision
+ Life Insurance
+ 401k
+ Paid Time Off
*#LI-REMOTE
**EEO Information**
Fujifilm is committed to providing equal opportunities in hiring, promotion and advancement, compensation, benefits, and training regardless of nationality, age, gender, sexual orientation or gender identity, race, ethnicity, religion, political creed, ideology, national, or social origin, disability, veteran status, etc.
**ADA Information**
If you require reasonable accommodation in completing this application, interviewing, completing any pre-employment testing, or otherwise participating in the employee selection process, please direct your inquiries to our HR Department ( ).
**Job Locations** _US-Remote_
**Posted Date** _6 days ago_ _(10/3/ :43 AM)_
**_Requisition ID_** _ _
**_Category_** _Legal_
**_Company (Portal Searching)_** _FUJIFILM Holdings America Corporation_

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

**Become a part of our caring community and help us put health first**
The Medical Director relies on medical background and reviews health claims. The Medical Director work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.
The Medical Director provides medical interpretation and decisions about the appropriateness of services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards. Begins to influence department's strategy. Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments.
**Use your skills to make an impact**
**Responsibilities**
The Medical Director provides medical interpretation and determinations whether services provided by other healthcare professionals are in agreement with national guidelines, CMS requirements, Humana policies, clinical standards, and (in some cases) contracts. The ideal candidate supports and collaborates with other team members, other departments and Humana colleagues After completion of mentored training, daily work is performed with minimal direction. Enjoys working in a structured environment with expectations for consistency in thinking and authorship. Exercises independence in meeting departmental expectations, and meets compliance timelines.
**Required Qualifications**
+ MD or DO degree
+ 5+ years of direct clinical patient care experience post residency or fellowship, which preferably includes some experience in an inpatient environment and/or related to care of a Medicare type population (disabled or >65 years of age).
+ Current and ongoing Board Certification an approved ABMS Medical Specialty
+ A current and unrestricted license in at least one jurisdiction and willing to obtain additional license, if required.
+ No current sanction from Federal or State Governmental organizations, and able to pass credentialing requirements.
+ Excellent verbal and written communication skills .
+ Evidence of analytic and interpretation skills, with prior experience participating in teams focusing on quality management, utilization management, case management, discharge planning and/or home health or post acute services such as inpatient rehabilitation.
**Preferred Qualifications**
+ Knowledge of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical management organizations, hospitals/ Integrated Delivery Systems, health insurance, other healthcare providers, clinical group practice management.
+ Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial health insurance.
+ Experience with national guidelines such as MCG® or InterQual
+ Internal Medicine, Family Practice, Geriatrics, Hospitalist, Emergency Medicine clinical specialists
+ Advanced degree such as an MBA, MHA, MPH
+ Exposure to Public Health, Population Health, analytics, and use of business metrics.
+ Experience working with Case managers or Care managers on complex case management, including familiarity with social determinants of health.
+ The curiosity to learn, the flexibility to adapt and the courage to innovate
**Additional Information**
Typically reports to a Lead, or Corporate Medical Director, depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an assigned market, member population, or condition type. May also engage in grievance and appeals reviews. May participate on project teams or organizational committees.
#physiciancareers
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
**Scheduled Weekly Hours**
40
**Pay Range**
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$223,800 - $313,100 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
**Description of Benefits**
Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
Application Deadline:
**About us**
Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.
**Equal Opportunity Employer**
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our