Formulary and Medical Strategies Senior Professional

08629 Trenton, New Jersey Humana

Posted 4 days ago

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Job Description

**Become a part of our caring community and help us put health first**
The Senior Professional collaborates with healthcare professionals, pharmacists, and other business functions to implement formulary and medical strategies for the Medicaid line of business. 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.
The Senior Formulary Operations Management Professional collaborates with healthcare professionals, pharmacists, and other business functions to implement formulary and medical strategies for the Medicaid line of business.
+ Utilizes broad understanding of pharmacy, managed care, PBM, market and regulatory insights to support the implementation of formulary and medical strategies to mitigate Humana's costs and trend while improving our member's health outcomes and costs.
+ Performs formulary and medical drug list analysis and reporting that assist in the decision making of Medicaid drug strategies.
+ Works across multiple departments to support Medicaid drug list changes for member communications (monthly, quarterly, and ad-hoc).
+ Prepares presentations to executive-level audiences on our Medicaid strategies.
+ Works with appropriate business partners to ensure accurate and timely implementation of formulary and medical strategies.
+ Ensures Humana's business processes are compliant with state Medicaid contracts and provides appropriate attestation and evidence for audits and accreditation.
+ Develops key performance indicators and plans to drive overall process improvements and efficiency for the Medicaid line of business.
+ Serves as a key representative for Medicaid strategies across the organization.
+ 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.
+ Drives for standardization and transparency with an aggressive focus on process documentation.
**Key Competencies:**
+ **Acts** **Strategically** : Has vision, anticipates future consequences and trends accurately; has broad knowledgeand perspective; createscompetitive and breakthrough strategies and plans.
+ **Builds Trust** : You honor your word by doingwhat you say you are going to do.
+ **Drives for Excellence** : You are a continuouslearner who encouragesothers to learn. By constantly upgrading your own work, you achieve results and outperform the competition.
+ **Innovates** :Introduces or develops new ideasand processes whichimprove performance or productivity.
+ **Implementation/Execution** : You are good at organizing and managing multiple priorities and/or projects by usingappropriatemethodologies and tools.
+ **Problem** **Solving** : You are a problem solver with the ability to encourage others incollaborativeproblemsolving.Acting as both a broker and consultant regarding resources, you engage others in problem solving without taking over.
**Use your skills to make an impact**
Required Qualifications:
+ Bachelor's degree or equivalent
+ 3+ years of experience in managed care or other pharmacy related field
+ 3+ years of experience of leading successful implementation of projects
+ 3+ years of technical experience required for data analysis and reporting
+ Experience in analysis and problem-solving
+ Excellent oral and written communication skills, previous experience presenting and interacting with senior leadership
+ Flexible, dynamic personality who works well in a team environment and is also an individual contributor
+ Ability to prioritize, organizes, and executes effective time management
+ Ability to assimilate, analyze, draw conclusions, and make recommendations from complex data
+ Ability to work in either a team or an individual capacity to achieve goals and meet deadlines
+ Successful track record in facilitating and consulting across teams and managing projects
+ Comprehensive knowledge of all Microsoft Office applications, including Excel, Word, Powerpoint, Project, and Visio.
**Preferred Qualifications:**
+ Master's degree
+ Knowledge of Medicaid business as it relates to pharmacy or medical drugs
+ Experience in finance and/or business-related pharmacy practice
+ Lean certification or Six Sigma Black belt
**Additional Information** :
As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.
**Work at home requirements:**
To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:
At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested.
Satellite, cellular and microwave connection can be used only if approved by leadership.
Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
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.
$86,300 - $118,700 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: 09-04-2025
**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
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Senior Inpatient Medical Coding Auditor Professional

08629 Trenton, New Jersey Humana

Posted 5 days ago

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Job Description

**Become a part of our caring community and help us put health first**
The Senior Inpatient Medical Coding Professional extracts clinical information from a variety of medical records and assigns appropriate procedural terminology and medical codes (e.g., ICD-10-CM, PCS) to patient records. This position works assignments involving moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.
**Responsibilities**
The Senior Inpatient Medical Coding Professional confirms appropriate diagnosis related group (DRG) assignments. Analyzes, enters and manipulates database. Responds to or clarifies internal requests for medical information.
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.
+ Reviewing staff monthly QA review variances
+ Daily inventory monitoring and assignment of escalated inventory
+ Research on guidelines - CMS, AMA, etc.
+ Training new coders/auditors
+ Responsible for updating and maintaining processes/resources/guidelines in OneNote & Mentor
+ Point of contact for coders/auditors
+ Assist coders with coding or technical issues
+ Team Engagement
+ Assist with assignments as appropriate per leader direction
**Use your skills to make an impact**
**WORK STYLE:** Remote/work at home. While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
**WORK HOURS:** Typical work hours are Monday-Friday, 8 hours/day, 5 days/week. Start time is typically between 7AM-8AM EST.
Overtime might be offered but is not mandatory.
**Required Qualifications**
+ Experience with all of the following: Inpatient medical coding, analytics, health record security and privacy, HIPAA compliance, and data governance.
+ Hold at least one of the following AHIMA Coding Certifications: RHIT, RHIA, or CCS
+ Comprehensive knowledge of MS Word, Excel and PowerPoint
+ Must be passionate about contributing to an organization focused on continuously improving consumer experiences
+ Experience implementing timely resolution to complex issues
**Preferred Qualifications**
+ Associate or Bachelor's degree
+ Previous leadership experience
**Additional Information**
**Work at Home Requirements**
- At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested
- Satellite, cellular and microwave connection can be used only if approved by leadership
- Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
- Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.
- Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
**Interview Format**
As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Hire Vue (formerly Modern Hire) to enhance our hiring and decision-making ability. Hire Vue (formerly Modern Hire allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.
If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.
If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.
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.
$71,100 - $97,800 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: 08-31-2025
**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
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Medical Director, Medical Affairs - Dermatology

08805 Bound Brook, New Jersey New Jersey Staffing

Posted 1 day ago

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Job Description

Medical Director, Medical Affairs - Dermatology

Insmed is a global biopharmaceutical company on a mission to transform the lives of patients living with serious and rare diseases. Our most valuable resource is our employees, and everything we do is motivated by a patient-first mentality. We are dedicated to growing our team with talented individuals from around the world who are willing to challenge the status quo, solve problems, and work collaboratively with a sense of urgency and compassion. Guided by our core values of collaboration, accountability, passion, respect, and integrity, we aim to foster an inclusive, diverse, and flexible work environment, where our employees are recognized for leaning in and rolling up their sleeves. If you share our vision and want to work with the most dedicated people in the biopharma industry, come to Insmed to accelerate your career. Consistently Ranked Science's Top Employer Insmed is dedicated to creating a collaborative environment where our team can thrive. Every day, our employees turn their passion for science and research into innovative solutions for patients. That's why we've been named the No. 1 company to work for in the biopharma industry in Science's Top Employers survey for four years in a row. A Certified Great Place to Work We believe our company is truly special, and our employees agree. We are also honored to have been listed on the Best Workplaces in Biopharma, Best Workplaces in New York, PEOPLE Companies That Care, Best Workplaces for Women, Best Workplaces for Millennials, and Best Medium Workplaces lists.

Overview

The Medical Director, Medical Affairs - Dermatology role will be responsible for supporting the product through its life cycle for hidradenitis suppurativa (HS) via leadership, mentorship, and execution of the Medical Affairs strategic vision. This position will report directly to the Executive Director of Medical Affairs. Together with the Executive Director of Medical Affairs, this role will be responsible for supporting all relevant commercialization activities including launch activities for HS. This individual will play a meaningful role in engagement of the external medical community.

Responsibilities

* Leadership role within a cross functional team of medical professionals in planning and driving all aspects of the integrated medical affairs plans for the asset. * Responsible for Medical Affairs interactions of external medical experts and leadership of medical advisory boards. * Provide Medical Affairs support in the development of the asset development strategy, LCM/IIR Strategy, and the design and execution of Phase 4 company sponsored studies, including HEOR studies and registries. * Lead and execute on innovative omnichannel medial education. * Provide medical expertise into the marketing strategies for the asset. * Provide review of medical and commercial materials, including standard medical information response documents, and materials used by Field Medical. * Provide medical support in developing the medical communications strategy (abstracts, posters, publications). * Provide medical support in developing the strategy for Independent Medical Education in compliance with internal processes. * Provide strategic medical support to Drug Safety for any product alerts in the US. * Provide strategic support to the evaluation of data gaps and provide support to the processes related to Investigator Initiated Studies. * Work collaboratively with key intra- and inter- departmental partners (Field Medical, Medical Operations, Medical Information, Medical Grants, HEOR, Medical Education, Clinical Development, Legal, Regulatory, Commercial, Market Access, etc.)

Requirements

* Dermatologist or MD is highly preferred but may consider PhD or PharmD with appropriate experience in the dermatological therapeutic arena. * 5+ years of experience in a biotechnology or pharmaceutical company in Medical Affairs is required. * Prior experience in dermatology or related therapeutic area highly preferred. * Experience in academic clinical research or pharmaceutical Clinical Development is a plus. * Experience with a growing medical team is a plus. * Experience working with HEOR is a plus. * Proven understanding of legal, regulatory, and compliance policies. * Demands a keen understanding of business operations with critical thinking and highly effective analytical skills. * Must have excellent communication and presentation skills (verbal and written). * Highly organized with a strong attention to detail, clarity, accuracy, and conciseness.

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Medical Director, Medical Affairs - Pulmonology

08805 Bound Brook, New Jersey Insmed

Posted 3 days ago

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Job Description

Medical Director, Medical Affairs - Pulmonology

The Medical Director, Medical Affairs - Pulmonology will develop, implement, and lead the indication strategy and planning for Medical Affairs across all geographic regions ensuring a cohesive approach. This role will develop and lead all medical affairs activities for the indication ensuring partnership within the team (medical strategy, scientific communications and publications) all key Medical Affairs functions (Medical Excellence, HEOR, Field Medical, Medical Information) as well as maintaining a high-level cross-functional collaboration across the organization to ensure alignment and One Insmed approach.

Responsibilities
  • Medical Strategy: Establish, and shape medical strategy ensuring this fits within the overall company strategy and there is cross functional alignment.
  • Development and execution of MA plans: Ensure that strategy is reflected in medical plans and that these deliver on critical identified milestones in launch planning.
  • Medical leadership input for cross functional partners including clinical, operations, HEOR and commercial to ensure that there is a strong medical voice represented.
  • Build External relationship network across therapy area to support the indication, and gain advice.
  • Develop data generation strategy including gap analysis, to evolve product data generation plans and ensure there is OneMedical strategy.
  • Review publications, help create medical backgrounders, FAQ and standard responses, and develop internal training approach.
  • Develop full thought leader engagement strategic approach and ensuing plan.
  • Partner with Medical Strategy, Regions, and Finance to plan and manage annual budget for medical activities.
  • Ensure a comprehensive and harmonious approach by collaborating across Medical Affairs, Regions, and other functions including Commercial and Development. Drive a One Insmed and respiratory Franchise approach.
  • Partner with team members to identify and integrate innovative ideas and standard processes into strategies, plans, and activities.
  • Ensure compliance with all applicable Insmed policies.
Position Requirements (Required and/or Preferred Skills, Experience and Education):
  • MD degree (preferred), PharmD or PhD, with 6+ years experience.
  • Previous experience in pulmonology/respiratory and/or allergy is strongly preferred.
  • Strong knowledge of Medical Affairs and understanding of medical affairs planning required with previous launch experience preferred.
  • Demonstrated ability to develop innovative approaches within Medical Affairs.
  • Ability to work independently and comfortable to be the MA representation within cross functional teams.
  • Ability to operate seamlessly in a matrixed organization.
  • Previous leadership experience in medical affairs and ability to lead by influence within a matrixed team.
  • Global experience or experience in multiple regions including the US is an advantage.
  • Ability to work collaboratively with multiple partners and functions.
  • Proven track record of leading process and operational excellence and developing planning standards.
  • Strong attention to detail.
  • Strong critical thinking skills with ability to connect multiple components.
  • Proven track record of effectively leading change.
  • Strong communication skills (written, verbal).
  • Ability to enable creative problem solving, encourage unique solutions, and effectively solve challenging problems.
  • Ability to travel domestically and internationally - up to 25% travel.
Salary Range

$252,000 - $302,267 a year

Compensation & Benefits

At Insmed, we're committed to investing in every team member's total well-being, now and in the future. Our benefit programs vary by country but we offer the following to all Insmed team members, regardless of geographic location:

  • Flexible approach to how we work
  • Health benefits and time-off plans
  • Competitive compensation package, including bonus
  • Equity Awards (Long-Term Incentives)
  • Employee Stock Purchase Plan (ESPP)

For more information on U.S. benefits click here.

Additional Information

Insmed Incorporated is an Equal Opportunity employer. We do not discriminate in hiring on the basis of physical or mental disability, protected veteran status, or any other characteristic protected by federal, state, or local law. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected Veteran status, age, or any other characteristic protected by law.

Unsolicited resumes from agencies should not be forwarded to Insmed. Insmed will not be responsible for any fees arising from the use of resumes through this source. Insmed will only pay a fee to agencies if a formal agreement between Insmed and the agency has been established. The Human Resources department is responsible for all recruitment activities; please contact us directly to be considered for a formal agreement.

Insmed is committed to providing access, equal opportunity, and reasonable accommodation for individuals with disabilities in employment, its services, programs, and activities. To request reasonable accommodation to participate in the job application or interview process, please contact us by email at TotalRewards@ and let us know the nature of your request and your contact information. Requests for accommodation will be considered on a case-by-case basis. Please note that only inquiries concerning a request for reasonable accommodation will be responded to from this email address.

Applications are accepted for 5 calendar days from the date posted or until the position is filled.

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Medical Director, Medical Affairs - Pulmonology

08805 Bound Brook, New Jersey Insmed

Posted 10 days ago

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Job Description

Medical Director, Medical Affairs - Pulmonology

The Medical Director, Medical Affairs - Pulmonology will develop, implement, and lead the indication strategy and planning for Medical Affairs across all geographic regions ensuring a cohesive approach. This role will develop and lead all medical affairs activities for the indication ensuring partnership within the team (medical strategy, scientific communications and publications) all key Medical Affairs functions (Medical Excellence, HEOR, Field Medical, Medical Information) as well as maintaining a high-level cross-functional collaboration across the organization to ensure alignment and One Insmed approach.

Responsibilities
  • Medical Strategy: Establish, and shape medical strategy ensuring this fits within the overall company strategy and there is cross functional alignment.
  • Development and execution of MA plans: Ensure that strategy is reflected in medical plans and that these deliver on critical identified milestones in launch planning.
  • Medical leadership input for cross functional partners including clinical, operations, HEOR and commercial to ensure that there is a strong medical voice represented.
  • Build External relationship network across therapy area to support the indication, and gain advice.
  • Develop data generation strategy including gap analysis, to evolve product data generation plans and ensure there is OneMedical strategy.
  • Review publications, help create medical backgrounders, FAQ and standard responses, and develop internal training approach.
  • Develop full thought leader engagement strategic approach and ensuing plan.
  • Partner with Medical Strategy, Regions, and Finance to plan and manage annual budget for medical activities.
  • Ensure a comprehensive and harmonious approach by collaborating across Medical Affairs, Regions, and other functions including Commercial and Development. Drive a One Insmed and respiratory Franchise approach.
  • Partner with team members to identify and integrate innovative ideas and standard processes into strategies, plans, and activities.
  • Ensure compliance with all applicable Insmed policies.
Position Requirements (Required and/or Preferred Skills, Experience and Education):
  • MD degree (preferred), PharmD or PhD, with 6+ years experience.
  • Previous experience in pulmonology/respiratory and/or allergy is strongly preferred.
  • Strong knowledge of Medical Affairs and understanding of medical affairs planning required with previous launch experience preferred.
  • Demonstrated ability to develop innovative approaches within Medical Affairs.
  • Ability to work independently and comfortable to be the MA representation within cross functional teams.
  • Ability to operate seamlessly in a matrixed organization.
  • Previous leadership experience in medical affairs and ability to lead by influence within a matrixed team.
  • Global experience or experience in multiple regions including the US is an advantage.
  • Ability to work collaboratively with multiple partners and functions.
  • Proven track record of leading process and operational excellence and developing planning standards.
  • Strong attention to detail.
  • Strong critical thinking skills with ability to connect multiple components.
  • Proven track record of effectively leading change.
  • Strong communication skills (written, verbal).
  • Ability to enable creative problem solving, encourage unique solutions, and effectively solve challenging problems.
  • Ability to travel domestically and internationally - up to 25% travel.
Salary Range

$252,000 - $302,267 a year

Compensation & Benefits

At Insmed, we're committed to investing in every team member's total well-being, now and in the future. Our benefit programs vary by country but we offer the following to all Insmed team members, regardless of geographic location:

  • Flexible approach to how we work
  • Health benefits and time-off plans
  • Competitive compensation package, including bonus
  • Equity Awards (Long-Term Incentives)
  • Employee Stock Purchase Plan (ESPP)

For more information on U.S. benefits click here.

Additional Information

Insmed Incorporated is an Equal Opportunity employer. We do not discriminate in hiring on the basis of physical or mental disability, protected veteran status, or any other characteristic protected by federal, state, or local law. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected Veteran status, age, or any other characteristic protected by law.

Unsolicited resumes from agencies should not be forwarded to Insmed. Insmed will not be responsible for any fees arising from the use of resumes through this source. Insmed will only pay a fee to agencies if a formal agreement between Insmed and the agency has been established. The Human Resources department is responsible for all recruitment activities; please contact us directly to be considered for a formal agreement.

Insmed is committed to providing access, equal opportunity, and reasonable accommodation for individuals with disabilities in employment, its services, programs, and activities. To request reasonable accommodation to participate in the job application or interview process, please contact us by email at and let us know the nature of your request and your contact information. Requests for accommodation will be considered on a case-by-case basis. Please note that only inquiries concerning a request for reasonable accommodation will be responded to from this email address.

Applications are accepted for 5 calendar days from the date posted or until the position is filled.

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Medical Director - Medical Oncologist (Bloomfield)

07003 Bloomfield, New Jersey Cigna

Posted 6 days ago

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Job Description

full time
Medical Principal Job Description

Position scope:

Primarily regional with national level case work for Cigna Healthcare (CHC) -- Cigna.

Summary description of position : A Medical Principal performs medical review and case management activities. The physician provides clinical insight to the organization through peer review, benefit review, consultation, and service to internal and external customers. He/she will serve as a clinical educator and consultant to utilization management, case management, network, contracting, pharmacy, and service operations (claims). This is an entry to mid-level position for a physician interested in a career in health care administration.

Major responsibilities and required results:
  • Performs benefit-driven medical necessity reviews for coverage, case management, and claims resolution, using benefit plan information, applicable federal and state regulations, clinical guidelines, and best practice principles.
  • Works to achieve quality outcomes for customers/members with a focus on service and cost
  • Improves clinical outcomes through daily interactions with health care professionals using active listening, education, and excellent communication and negotiation skills.
  • Balances customer/member needs with business needs while serving as a customer/member advocate at all times.
  • Participates in all levels of the Appeal process as appropriate and allowed by applicable regulatory agencies and accreditation organizations
  • Participates in coverage guideline development, development and maintenance of medical management projects, initiatives and committees.
  • Participates in quality processes such as audits, inter-rater reliability clinical reviews, and quality projects
  • Serves as a mentor or coach to other Medical Directors and other colleagues in quality and performance improvement processes.
  • Improves health care professional relations through direct communication, knowledge of appropriate evidence-based clinical information and the fostering of positive collegial relationships.
  • Demonstrates knowledge as a peer reviewer by applying current evidence-based guidelines, including novel treatments, to support high-quality clinical decision-making across medical and behavioral health conditions, diseases, treatments, and procedures. Medical directors are required to maintain and update their knowledge base through monthly focused updates of Cigna's comprehensive evidence-based coverage policies, as well as through mandatory inter-rater reliability testing, continuing medical education, and maintenance of board certification.
  • Addresses customer service issues with mentoring and support from leadership staff.
  • Investigates and responds to client and/or regulatory questions to assist in resolving issues or clarifying questions with mentoring and support from leadership staff.
  • Achieves internal customer satisfaction and regulatory/accreditation agency compliance goals by assuring both timely turn-around of coverage reviews and quality outcomes based on those review decisions.
  • Provides clinical insight and management support to other functional areas and matrix partners as needed or directed.

Minimum Requirements:
  • Current unrestricted medical license in a US state or territory.
  • Current board certification (lifetime certification or certification maintained by MOC or other applicable program) in an ABMS or AOA recognized specialty
  • Exhibits ethical and professional behavior.
  • Minimum of 5 years of clinical practice experience and/or direct patient care beyond residency
  • Computer Competency: Word processing, Spreadsheet, Email, PowerPoint and Personal Information Management programs are used extensively and competency in all must be possessed or rapidly acquired.
  • Must not be excluded from participation in any federal health care program**
  • Must not be included in CMS' Preclusion List**

Preferred Skill Sets:
  • Experience in medical management, utilization review and case management in a managed care setting.
  • Knowledge of managed care products and strategies.
  • Ability to work within changing business environment and balance patient advocacy with business needs.
  • Experience with managing multiple projects in a fast-paced matrix environment.
  • Demonstrated ability to educate colleagues and staff members.
  • Successful experience and comfort with change management.
  • Demonstration of strong and effective abilities in teamwork, negotiation, conflict management, decision-making, and problem-solving skills.
  • Successful ability to assess complex issues, to determine and implement solutions, and resolve problems.
  • Success in creating and maintaining cooperative, successful relations with diverse internal and external stakeholders.
  • Demonstrated sensitivity to culturally diverse situations, participants, and customers/members.
  • Service marketing, sales, and business acumen experience a plus.
  • Fluency in Spanish (Cigna Medicare) or other languages


If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.

For this position, we anticipate offering an annual salary of 206,300 - 343,900 USD / yearly, depending on relevant factors, including experience and geographic location.

This role is also anticipated to be eligible to participate in an annual bonus and long term incentive plan.

We want you to be healthy, balanced, and feel secure. That's why you'll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you'll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at Cigna Group .

About The Cigna Group

Doing something meaningful starts with a simple decision, a commitment to changing lives. At The Cigna Group, we're dedicated to improving the health and vitality of those we serve. Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients. Join us in driving growth and improving lives.

Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.

If you require reasonable accommodation in completing the online application process, please email: for support. Do not email for an update on your application or to provide your resume as you will not receive a response.

The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.

Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances. #J-18808-Ljbffr
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Medical Director - Medical Oncology (Pennington)

08534 Pennington, New Jersey Weatherby Healthcare

Posted 12 days ago

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Job Description

full time

Capital Health is the region's leader in providing progressive, quality patient care with significant investments in our exceptional physicians, nurses and staff, as well as advance technology. Capital Health is a five-time Magnet-Recognized health system for nursing excellence and is comprised of 2 hospitals. Capital Health Medical Group is made up of more than 250 physicians and other providers who offer primary and specialty care, as well as hospital-based services, to patients throughout the region.

Capital Health recognizes that attracting the best talent is key to our strategy and success as an organization.As a result, we aim for flexibility in structuring competitive compensation offers to ensure we can attract the best candidates.

Position Overview

Minimum Pay:

$433,368.00

Capital Health, a leading health system in New Jersey dedicated to delivering outstanding cancer care, is seeking a dynamic and experienced Medical Director for Medical Oncology to join and lead our multidisciplinary team at the Capital Health Cancer Center. This individual will be responsible for advancing clinical excellence, quality outcomes, and strategic growth within our Medical Oncology program.

Opportunity Details:

  • Provide clinical leadership and administrative oversight to the Medical Oncology team, including physicians and advanced practice providers.
  • Develop and implement best practices, protocols, and standards of care aligned with evidence-based oncology treatment.
  • Collaborate with Cancer Center leadership to grow and enhance oncology services, including infusion, outpatient clinics, and supportive care.
  • Lead programmatic initiatives to expand access, improve patient experience, and maintain accreditation standards (e.g., CoC, ASCO QOPI).
  • Maintain an active clinical practice within Medical Oncology, serving patients with a broad spectrum of cancer diagnoses.
  • Monitor quality metrics and lead continuous performance improvement initiatives.
  • Mentor junior physicians and participate in training programs for fellows and residents.

Qualifications:

MD or DO with board certification in Medical Oncology (Hematology/Oncology preferred).

Minimum 5 years of clinical oncology experience, with demonstrated leadership responsibilities.

Active NJ medical license (or eligibility for licensure).

Proven experience in program development, quality improvement, and multidisciplinary care coordination.

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Medical Director - Medical Oncology (Pennington)

08534 Pennington, New Jersey International Society on Thrombosis and Hemostasis

Posted 12 days ago

Job Viewed

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Job Description

full time

Capital Health is the region's leader in providing progressive, quality patient care with significant investments in our exceptional physicians, nurses and staff, as well as advance technology. Capital Health is a five-time Magnet-Recognized health system for nursing excellence and is comprised of 2 hospitals. Capital Health Medical Group is made up of more than 250 physicians and other providers who offer primary and specialty care, as well as hospital-based services, to patients throughout the region.

Capital Health recognizes that attracting the best talent is key to our strategy and success as an organization. As a result, we aim for flexibility in structuring competitive compensation offers to ensure we can attract the best candidates.

Position Overview

Minimum Pay:

$433,368.00

Capital Health, a leading health system in New Jersey dedicated to delivering outstanding cancer care, is seeking a dynamic and experienced Medical Director for Medical Oncology to join and lead our multidisciplinary team at the Capital Health Cancer Center. This individual will be responsible for advancing clinical excellence, quality outcomes, and strategic growth within our Medical Oncology program.


Opportunity Details:

  • Provide clinical leadership and administrative oversight to the Medical Oncology team, including physicians and advanced practice providers.
  • Develop and implement best practices, protocols, and standards of care aligned with evidence-based oncology treatment.
  • Collaborate with Cancer Center leadership to grow and enhance oncology services, including infusion, outpatient clinics, and supportive care.
  • Lead programmatic initiatives to expand access, improve patient experience, and maintain accreditation standards (e.g., CoC, ASCO QOPI).
  • Maintain an active clinical practice within Medical Oncology, serving patients with a broad spectrum of cancer diagnoses.
  • Monitor quality metrics and lead continuous performance improvement initiatives.
  • Mentor junior physicians and participate in training programs for fellows and residents.

Qualifications:


MD or DO with board certification in Medical Oncology (Hematology/Oncology preferred).
Minimum 5 years of clinical oncology experience, with demonstrated leadership responsibilities.
Active NJ medical license (or eligibility for licensure).
Proven experience in program development, quality improvement, and multidisciplinary care coordination.

Offers are contingent upon successful completion of our onboarding process and pre-employment physical. Capital Health will require all applicants to have an annual flu vaccine prior to start date, with the exception of individuals with medical and religious exemptions.

Company will never ask candidates for social security numbers or date of birth during application phase. If you are asked for this information online, you may be a target for identity theft.

For benefit eligible roles, in addition to cash compensation, we provide a comprehensive and highly competitive benefits package, with a variety of physical health, retirement and savings, caregiving, emotional wellbeing, transportation, robust PTO plan, overtime to eligible roles, and other benefits, including elective benefits employees may select to best fit the needs and personal situations of our diverse workforce.

The pay rate listed is a good faith determination of potential base compensation that may be offered to a successful applicant for this position at the time of this job advertisement and may be modified in the future. When determining base salary and/or rate, several factors may be considered including, but not limited to location, years of relevant experience, education, credentials, negotiated contracts, budget, market data, and internal equity. Bonus and/or incentive eligibility are determined by role and level.

The salary applies specifically to the position being advertised and does not include potential bonuses, incentive compensation, differential pay or other forms of compensation, compensation allowance, or benefits health or welfare. Actual total compensation may vary based on factors such as experience, skills, qualifications, and other relevant criteria.

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Medical Director - Medical Oncology (Pennington)

08534 Pennington, New Jersey Capital Health (US)

Posted 12 days ago

Job Viewed

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Job Description

full time

Join to apply for the Medical Director - Medical Oncology role at Capital Health (US)

1 week ago Be among the first 25 applicants

Join to apply for the Medical Director - Medical Oncology role at Capital Health (US)

Capital Health is the region's leader in providing progressive, quality patient care with significant investments in our exceptional physicians, nurses and staff, as well as advance technology. Capital Health is a five-time Magnet-Recognized health system for nursing excellence and is comprised of 2 hospitals. Capital Health Medical Group is made up of more than 250 physicians and other providers who offer primary and specialty care, as well as hospital-based services, to patients throughout the region.

Capital Health recognizes that attracting the best talent is key to our strategy and success as an organization. As a result, we aim for flexibility in structuring competitive compensation offers to ensure we can attract the best candidates.

Position Overview

Minimum Pay:

$433,368.00

Capital Health, a leading health system in New Jersey dedicated to delivering outstanding cancer care, is seeking a dynamic and experienced Medical Director for Medical Oncology to join and lead our multidisciplinary team at the Capital Health Cancer Center. This individual will be responsible for advancing clinical excellence, quality outcomes, and strategic growth within our Medical Oncology program.

Opportunity Details

  • Provide clinical leadership and administrative oversight to the Medical Oncology team, including physicians and advanced practice providers.
  • Develop and implement best practices, protocols, and standards of care aligned with evidence-based oncology treatment.
  • Collaborate with Cancer Center leadership to grow and enhance oncology services, including infusion, outpatient clinics, and supportive care.
  • Lead programmatic initiatives to expand access, improve patient experience, and maintain accreditation standards (e.g., CoC, ASCO QOPI).
  • Maintain an active clinical practice within Medical Oncology, serving patients with a broad spectrum of cancer diagnoses.
  • Monitor quality metrics and lead continuous performance improvement initiatives.
  • Mentor junior physicians and participate in training programs for fellows and residents.

Qualifications

  • MD or DO with board certification in Medical Oncology (Hematology/Oncology preferred).
  • Minimum 5 years of clinical oncology experience, with demonstrated leadership responsibilities.
  • Active NJ medical license (or eligibility for licensure).
  • Proven experience in program development, quality improvement, and multidisciplinary care coordination.

Offers are contingent upon successful completion of our onboarding process and pre-employment physical. Capital Health will require all applicants to have an annual flu vaccine prior to start date, with the exception of individuals with medical and religious exemptions.

Company will never ask candidates for social security numbers or date of birth during application phase. If you are asked for this information online, you may be a target for identity theft.

For benefit eligible roles, in addition to cash compensation, we provide a comprehensive and highly competitive benefits package, with a variety of physical health, retirement and savings, caregiving, emotional wellbeing, transportation, robust PTO plan, overtime to eligible roles, and other benefits, including elective benefits employees may select to best fit the needs and personal situations of our diverse workforce.

The pay rate listed is a good faith determination of potential base compensation that may be offered to a successful applicant for this position at the time of this job advertisement and may be modified in the future. When determining base salary and/or rate, several factors may be considered including, but not limited to location, years of relevant experience, education, credentials, negotiated contracts, budget, market data, and internal equity. Bonus and/or incentive eligibility are determined by role and level.

The salary applies specifically to the position being advertised and does not include potential bonuses, incentive compensation, differential pay or other forms of compensation, compensation allowance, or benefits health or welfare. Actual total compensation may vary based on factors such as experience, skills, qualifications, and other relevant criteria.

Seniority level
  • Seniority level Director
Employment type
  • Employment type Full-time
Job function
  • Job function Health Care Provider
  • Industries Hospitals and Health Care

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Medical Director

08543 Princeton, New Jersey Genmab

Posted today

Job Viewed

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Job Description

At Genmab, we are dedicated to building extra(not)ordinary® futures, together, by developing antibody products and groundbreaking, knock-your-socks-off KYSO antibody medicines® that change lives and the future of cancer treatment and serious diseases. We strive to create, champion and maintain a global workplace where individuals' unique contributions are valued and drive innovative solutions to meet the needs of our patients, care partners, families and employees. Our people are compassionate, candid, and purposeful, and our business is innovative and rooted in science. We believe that being proudly authentic and determined to be our best is essential to fulfilling our purpose. Yes, our work is incredibly serious and impactful, but we have big ambitions, bring a ton of care to pursuing them, and have a lot of fun while doing so. Does this inspire you and feel like a fit? Then we would love to have you join us! The Role : We are looking for an experienced and dedicated Medical Director to be a part of our Global Clinical Development Team. The Medical Director will be accountable for the medical oversight of one or more clinical trials, medical review and communication of data, and medical input into regulatory documents and presentations. Responsibilities: · Lead the development of the program strategy for assigned trials/compounds and participate in the development of the clinical development plan (CDP). · Lead creation and review of clinical components of key documents, clinical and regulatory documents, annual safety updates, and registration dossiers (ie, protocol, ICF, IB, annual safety updates, study reports, regulatory submissions (Briefing documents, IND, Clinical dossiers) supporting registration, market access, and commercialization of the compound(s). · Oversee early-stage programs and develop clinical programs including component studies. · Oversee safety of the drug, including the safety aspects of patients in clinical studies and signal detection with support of the Safety physician · Create, integrate, and execute overall medical strategies of assigned clinical development programs; provide strategic medical advice on potential new projects (internal & external). · Contribute to publication and clinical communication strategy in coordination with Scientific Communications; provide inputs to key external presentations Provide strategic input and development support for clinical plans and individual trial protocols. · Interact with key opinion leaders to ensure implementation of the latest clinical and medical thinking and guidelines into clinical development plans, as well as consideration of novel medical methods development and new potential targets. · Contribute to medical department best practices, standardization and to cross-functional process improvements. · Support the development of case report forms, perform medical monitoring, liaise with investigators and site personnel, perform preliminary and exploratory data analyses on clinical trials, author clinical study reports, provide input on publication materials, and participate in advisory boards. · Support the development of other relevant documents that are necessary for the advancement of the product pipeline. · Serve as medical and technical resource for clinical issues raised by internal and external collaborators, investigators, consultants and contractors. Create medical deliverables: clinical development plans, concept sheets, briefing books, and label and marketing application dossier. · Contribute to medical input to preclinical development of candidate therapeutic antibodies. · Drive and monitor quality of all clinical documents (e.g., Investigators' Brochures, protocols, study reports, clinical components of regulatory submissions, safety documents) produced by CDT. · Participate in multi-function teams necessary for the advancement of the product pipeline. · Attend relevant congresses or other relevant fora to maintain up-to-date scientific/medical knowledge. Requirements: · MD degree. · Minimum of 3 years of directly related industry experience within oncology or hematology. · Significant experience with relevant areas of oncology. · Proven ability to build and lead teams and inspire trust among colleagues. · Experience representing team and organization in a variety of internal/external settings. · Experience training and managing team members. · Proven performance in earlier role/comparable role. For US based candidates, the proposed salary band for this position is as follows: $254,800.00$382,200.00 The actual salary offer will carefully consider a wide range of factors, including your skills, qualifications, experience, and location. Also, certain positions are eligible for additional forms of compensation, such as discretionary bonuses and long-term incentives. When you join Genmab, you're joining a culture that supports your physical, financial, social, and emotional wellness. Within the first year, regular full-time U.S. employees are eligible for: 401(k) Plan: 100% match on the first 6% of contributions Health Benefits: Two medical plan options (including HDHP with HSA), dental, and vision insurance Voluntary Plans: Critical illness, accident, and hospital indemnity insurance Time Off: Paid vacation, sick leave, holidays, and 12 weeks of discretionary paid parental leave Support Resources: Access to child and adult backup care, family support programs, financial wellness tools, and emotional well-being support Additional Perks: Commuter benefits, tuition reimbursement, and a Lifestyle Spending Account for wellness and personal expenses About You You are genuinely passionate about our purpose You bring precision and excellence to all that you do You believe in our rooted-in-science approach to problem-solving You are a generous collaborator who can work in teams with a broad spectrum of backgrounds You take pride in enabling the best work of others on the team You can grapple with the unknown and be innovative You have experience working in a fast-growing, dynamic company (or a strong desire to) You work hard and are not afraid to have a little fun while you do so! Locations Genmab maximizes the efficiency of an agile working environment, when possible, for the betterment of employee work-life balance. Our offices are crafted as open, community-based spaces that work to connect employees while being immersed in our powerful laboratories. Whether you're in one of our office spaces or working remotely, we thrive on connecting with each other to innovate. About Genmab Genmab is an international biotechnology company with a core purpose to improve the lives of patients through innovative and differentiated antibody therapeutics. For 25 years, its hard-working, innovative and collaborative team has invented next-generation antibody technology platforms and harnessed translational, quantitative and data sciences, resulting in a proprietary pipeline including bispecific T-cell engagers, antibody-drug conjugates, next-generation immune checkpoint modulators and effector function-enhanced antibodies. By 2030, Genmab's vision is to transform the lives of people with cancer and other serious diseases with Knock-Your-Socks-Off (KYSO®) antibody medicines. Established in 1999, Genmab is headquartered in Copenhagen, Denmark with international presence across North America, Europe and Asia Pacific. For more information, please visit Genmab.com and follow us on LinkedIn and X . Genmab is committed to protecting your personal data and privacy. Please see our privacy policy for handling your data in connection with your application on our website Job Applicant Privacy Notice (genmab.com) . Please note that if you are applying for a position in the Netherlands, Genmab's policy for all permanently budgeted hires in NL is initially to offer a fixed-term employment contract for a year, if the employee performs well and if the business conditions do not change, renewal for an indefinite term may be considered after the fixed-term employment contract.

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