516 Medical Staff jobs in Maryland

**Company :**
Highmark Inc.
**Job Description :**
**JOB SUMMARY**
This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and most current clinical standards. The incumbent reviews escalated cases electronically and using Medical Policy criteria sets to evaluate the medical necessity and appropriateness of the requested treatment of service. Depending on the nature of the case, telephonic peer to peer discussions may be required. The incumbent ensures compliance to NCQA, URAC, CMS, DOH, and DOL regulations at all times. In addition to utilization review, the incumbent participates as the physician member of the multidisciplinary team for case and disease management. They will advise the multidisciplinary team on cases, particularly high-risk cases, through the team structure. Additionally, the incumbent may be assigned special projects to help support and improve the care of our members
**ESSENTIAL RESPONSIBILITIES**
+ Conduct electronic review of escalated cases against medical policy criteria, which may include telephonic peer to peer discussions, to determine medical necessity and appropriateness. Complete initial determination of cases, review of appeals and grievances, and other reviews as assigned. Compose clear and concise rationales for member and provider determination notifications all while adhering to required compliance standards (NCQA, URAC, CMS, DOH, and DOL regulations, etc.). Ensure that all aspects of the medical management process are consistent with community standards of care.
+ Participate as a member of the CMDM multidisciplinary team. Attend huddles and grand rounds. Advise multidisciplinary team on cases that require physician expertise.
+ Participate in protocol and guidelines development to ensure consistency in the review process.
+ Actively manage projects and/or participate on project teams that require a physician subject matter expert.
+ Other duties as assigned.
**EDUCATION**
**Required**
+ Medical Doctor (MD) or Doctor of Osteopathic Medicine (DO)
**Substitutions**
+ None
**Preferred**
+ Master's Degree in Business Administration/Management or Public Health
**EXPERIENCE**
**Required**
+ 5 years in Clinical, Direct Patient care (hospital, outpatient, or private practice)
**Preferred**
+ 1 year in Medical Management in a Health Insurance Plan; strong knowledge of managed care industry
**LICENSES AND CERTIFICATION**
**Required**
+ Medical Doctor or Doctor of Osteopathic Medicine (DO)
+ Awarded Board Certification at least once in specialty recognized by the American Board of Medical Specialties or the American Osteopathic Association Specialty Certifying Boards
+ Active medical state licensure required. Additional specific state licensure(s) may be required based on business need.
**Preferred**
+ None
**SKILLS**
+ Critical Thinking
+ Case Management
+ Customer Service
+ Oral & Written Communication Skills
+ Collaboration
+ Listening
+ Telephone Skills
+ General Computer Skills
+ Clinical Software
+ Managed Care
**Language (Other than English)**
None
**Travel Required**
0% - 25%
**PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS**
Position Type
Office-Based
Teaches / trains others regularly
Occasionally
Travel regularly from the office to various work sites or from site-to-site
Rarely
Works primarily out-of-the office selling products/services (sales employees)
Never
Physical work site required
No
Lifting: up to 10 pounds
Constantly
Lifting: 10 to 25 pounds
Rarely
Lifting: 25 to 50 pounds
Rarely
**_Disclaimer:_** _The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job._
**_Compliance Requirement_** _: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies._
_As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company's Handbook of Privacy Policies and Practices and Information Security Policy._
_Furthermore, it is every employee's responsibility to comply with the company's Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements._
**Pay Range Minimum:**
$170,000.00
**Pay Range Maximum:**
$352,500.00
_Base pay is determined by a variety of factors including a candidate's qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets._
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.
We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below.
For accommodation requests, please contact HR Services Online at
California Consumer Privacy Act Employees, Contractors, and Applicants Notice
Req ID: J

**UPMC Western Maryland's Medical Oncology Department is looking for a full time Medical Assistant! This is position is designed to assist patients with assessments, preparing patients for exams, in addition to the responsibilities listed below. It you're looking for a consistent Monday through Friday position in a role that allows you to make a difference in the lives of our patients, make sure to apply today! Bonus points if you are a Certified Medical Assistant!**
+ Check schedules and organizing patient flow. Accompany patients to exam/procedure room. Assist patients as needed with walking, transfers, dressing, collecting specimens, preparing for exam, etc. Collect patient information/history; taking vitals, performing screenings per provider guidelines. Relay instructions to patients/families.
+ Send/receive patient medical records in accordance with Health Insurance. Portability and Accountability Act (HIPAA) and other state and federal regulations.
+ Prepare patient rooms, set up instruments and equipment according to department protocol. Clean exam/procedure rooms, instruments and equipment between patient visits to maintain infection control. Clean according to scheduled maintenance program and keeping appropriate records. Manage inventory of supplies; restocking exam/procedure rooms.
+ Comply with requirements of appropriate regulatory agencies (i.e. OSHA, CLIA, PA Department of Health). Maintain strict confidentiality related to medical records and other data. Comply with all UPMC Health System policies and procedures.
+ Perform phlebotomy, EKG's, and level one labs. Perform clinic procedures according to policy and procedure. Assist physicians with procedures. Document patient information into the medical record.
+ Answering calls and providing pertinent information including patient education as directed.
+ Obtain lab/x-ray reports, hospital notes, referral information, etc. Complete forms/requisitions as needed. Schedule appointments. Verify insurance coverage and patient demographics. Prepare and managing charts to ensure information completed and filed appropriately. Other front office responsibilities, as required.
+ Under the direction and supervision of a physician, administer injectable medication and vaccines when appropriate.
+ Send/receive patient medical records in accordance with Health Insurance. Portability and Accountability Act (HIPAA) and other state and federal regulations.
+ Obtain lab/x-ray reports, hospital notes, referral information, etc. Complete forms/requisitions as needed. Schedule appointments. Verify insurance coverage and patient demographics. Prepare and managing charts to ensure information completed and filed appropriately. Other front office responsibilities, as required.
+ Prepare patient rooms, set up instruments and equipment according to department protocol. Clean exam/procedure rooms, instruments and equipment between patient visits to maintain infection control. Clean according to scheduled maintenance program and keeping appropriate records. Manage inventory of supplies; restocking exam/procedure rooms.
+ Check schedules and organizing patient flow. Accompany patients to exam/procedure room. Assist patients as needed with walking, transfers, dressing, collecting specimens, preparing for exam, etc. Collect patient information/history, taking vitals, performing screenings per provider guidelines. Relay instructions to patients/families.
+ Answering calls and providing pertinent information including patient education as directed.
+ Perform phlebotomy, EKG's, and level one labs. Perform clinic procedures according to policy and procedure. Assist physicians with procedures. Document patient information into the medical record.
+ Comply with requirements of appropriate regulatory agencies (i.e., OSHA, CLIA, PA Department of Health). Maintain strict confidentiality related to medical records and other data. Comply with all UPMC Health System policies and procedures.
+ Under the direction and supervision of a physician, administer injectable medication and vaccines when appropriate.
+ High school diploma or equivalent is required.
+ Must have basic computer skills and knowledge of medical terminology, examination, diagnostic and treatment room responsibilities.
**Licensure, Certifications, and Clearances:**
+ CPR required based on AHA standards that include both a didactic and skills demonstration component within 30 days of hire.
+ Basic Life Support (BLS) OR Cardiopulmonary Resuscitation (CPR)
**UPMC is an Equal Opportunity Employer/Disability/Veteran**

**Company :**
Highmark Inc.
**Job Description :**
**JOB SUMMARY**
This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and most current clinical standards. The incumbent reviews escalated cases electronically and using Medical Policy criteria sets to evaluate the medical necessity and appropriateness of the requested treatment of service. Depending on the nature of the case, telephonic peer to peer discussions may be required. The incumbent ensures compliance to NCQA, URAC, CMS, DOH, and DOL regulations at all times. In addition to utilization review, the incumbent participates as the physician member of the multidisciplinary team for case and disease management. They will advise the multidisciplinary team on cases, particularly high-risk cases, through the team structure. Additionally, the incumbent may be assigned special projects to help support and improve the care of our members
**ESSENTIAL RESPONSIBILITIES**
+ Conduct electronic review of escalated cases against medical policy criteria, which may include telephonic peer to peer discussions, to determine medical necessity and appropriateness. Complete initial determination of cases, review of appeals and grievances, and other reviews as assigned. Compose clear and concise rationales for member and provider determination notifications all while adhering to required compliance standards (NCQA, URAC, CMS, DOH, and DOL regulations, etc.). Ensure that all aspects of the medical management process are consistent with community standards of care.
+ Participate as a member of the CMDM multidisciplinary team. Attend huddles and grand rounds. Advise multidisciplinary team on cases that require physician expertise.
+ Participate in protocol and guidelines development to ensure consistency in the review process.
+ Actively manage projects and/or participate on project teams that require a physician subject matter expert.
+ Other duties as assigned.
**EDUCATION**
**Required**
+ Medical Doctor (MD) or Doctor of Osteopathic Medicine (DO)
**Substitutions**
+ None
**Preferred**
+ Master's Degree in Business Administration/Management or Public Health
**EXPERIENCE**
**Required**
+ 5 years in Clinical, Direct Patient care (hospital, outpatient, or private practice)
**Preferred**
+ 1 year in Medical Management in a Health Insurance Plan; strong knowledge of managed care industry
**LICENSES AND CERTIFICATION**
**Required**
+ Medical Doctor or Doctor of Osteopathic Medicine (DO)
+ Awarded Board Certification at least once in specialty recognized by the American Board of Medical Specialties or the American Osteopathic Association Specialty Certifying Boards
+ Active medical state licensure required. Additional specific state licensure(s) may be required based on business need.
**Preferred**
+ None
**SKILLS**
+ Critical Thinking
+ Case Management
+ Customer Service
+ Oral & Written Communication Skills
+ Collaboration
+ Listening
+ Telephone Skills
+ General Computer Skills
+ Clinical Software
+ Managed Care
**Language (Other than English)**
None
**Travel Required**
0% - 25%
**PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS**
Position Type
Office-Based
Teaches / trains others regularly
Occasionally
Travel regularly from the office to various work sites or from site-to-site
Rarely
Works primarily out-of-the office selling products/services (sales employees)
Never
Physical work site required
No
Lifting: up to 10 pounds
Constantly
Lifting: 10 to 25 pounds
Rarely
Lifting: 25 to 50 pounds
Rarely
**_Disclaimer:_** _The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job._
**_Compliance Requirement_** _: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies._
_As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company's Handbook of Privacy Policies and Practices and Information Security Policy._
_Furthermore, it is every employee's responsibility to comply with the company's Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements._
**Pay Range Minimum:**
$170,000.00
**Pay Range Maximum:**
$352,500.00
_Base pay is determined by a variety of factors including a candidate's qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets._
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.
We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below.
For accommodation requests, please contact HR Services Online at
California Consumer Privacy Act Employees, Contractors, and Applicants Notice
Req ID: J

**Company :**
Highmark Inc.
**Job Description :**
**JOB SUMMARY**
This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and most current clinical standards. The incumbent reviews escalated cases electronically and using Medical Policy criteria sets to evaluate the medical necessity and appropriateness of the requested treatment of service. Depending on the nature of the case, telephonic peer to peer discussions may be required. The incumbent ensures compliance to NCQA, URAC, CMS, DOH, and DOL regulations at all times. In addition to utilization review, the incumbent participates as the physician member of the multidisciplinary team for case and disease management. They will advise the multidisciplinary team on cases, particularly high-risk cases, through the team structure. Additionally, the incumbent may be assigned special projects to help support and improve the care of our members
**ESSENTIAL RESPONSIBILITIES**
+ Conduct electronic review of escalated cases against medical policy criteria, which may include telephonic peer to peer discussions, to determine medical necessity and appropriateness. Complete initial determination of cases, review of appeals and grievances, and other reviews as assigned. Compose clear and concise rationales for member and provider determination notifications all while adhering to required compliance standards (NCQA, URAC, CMS, DOH, and DOL regulations, etc.). Ensure that all aspects of the medical management process are consistent with community standards of care.
+ Participate as a member of the CMDM multidisciplinary team. Attend huddles and grand rounds. Advise multidisciplinary team on cases that require physician expertise.
+ Participate in protocol and guidelines development to ensure consistency in the review process.
+ Actively manage projects and/or participate on project teams that require a physician subject matter expert.
+ Other duties as assigned.
**EDUCATION**
**Required**
+ Medical Doctor (MD) or Doctor of Osteopathic Medicine (DO)
**Substitutions**
+ None
**Preferred**
+ Master's Degree in Business Administration/Management or Public Health
**EXPERIENCE**
**Required**
+ 5 years in Clinical, Direct Patient care (hospital, outpatient, or private practice)
**Preferred**
+ 1 year in Medical Management in a Health Insurance Plan; strong knowledge of managed care industry
**LICENSES AND CERTIFICATION**
**Required**
+ Medical Doctor or Doctor of Osteopathic Medicine (DO)
+ Awarded Board Certification at least once in specialty recognized by the American Board of Medical Specialties or the American Osteopathic Association Specialty Certifying Boards
+ Active medical state licensure required. Additional specific state licensure(s) may be required based on business need.
**Preferred**
+ None
**SKILLS**
+ Critical Thinking
+ Case Management
+ Customer Service
+ Oral & Written Communication Skills
+ Collaboration
+ Listening
+ Telephone Skills
+ General Computer Skills
+ Clinical Software
+ Managed Care
**Language (Other than English)**
None
**Travel Required**
0% - 25%
**PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS**
Position Type
Office-Based
Teaches / trains others regularly
Occasionally
Travel regularly from the office to various work sites or from site-to-site
Rarely
Works primarily out-of-the office selling products/services (sales employees)
Never
Physical work site required
No
Lifting: up to 10 pounds
Constantly
Lifting: 10 to 25 pounds
Rarely
Lifting: 25 to 50 pounds
Rarely
**_Disclaimer:_** _The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job._
**_Compliance Requirement_** _: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies._
_As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company's Handbook of Privacy Policies and Practices and Information Security Policy._
_Furthermore, it is every employee's responsibility to comply with the company's Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements._
**Pay Range Minimum:**
$170,000.00
**Pay Range Maximum:**
$352,500.00
_Base pay is determined by a variety of factors including a candidate's qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets._
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.
We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below.
For accommodation requests, please contact HR Services Online at
California Consumer Privacy Act Employees, Contractors, and Applicants Notice
Req ID: J

**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.
Don't see the dream job you are looking for? Drop off your contact information and resume and we will reach out to you if we find the perfect fit!

**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.
Don't see the dream job you are looking for? Drop off your contact information and resume and we will reach out to you if we find the perfect fit!

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start **Caring. Connecting. Growing together.**
Here at Optum, we have an unrelenting focus on the customer journey and ensuring we exceed expectations as we deliver clinical coverage and medical claims reviews. Our role is to empower providers and members with the tools and information needed to improve health outcomes, reduce variation in care, deliver seamless experience, and manage health care costs.
The Medical Director provides physician support to Enterprise Clinical Services operations, the organization responsible for the initial clinical review of service requests for Enterprise Clinical Services. The Medical Director collaborates with Enterprise Clinical Services leadership and staff to establish, implement, support and maintain clinical and operational processes related to benefit coverage determinations, quality improvement and cost effectiveness of service for members. The Medical Director's activities primarily focus on the application of clinical knowledge in various utilization management activities with a focus on post-service benefit and coverage determination or medical necessity (according to the benefit package), and on communication regarding this process with both network and non-network physicians, as well as other Enterprise Clinical Services.
The Medical Director collaborates with a multidisciplinary team and is actively involved in the management of medical benefits. The collaboration often involves the member's primary care provider or specialist physician. It is the primary responsibility of the medical director to ensure that the appropriate and most cost effective quality medical care is provided to members.
You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.
**Primary Responsibilities:**
+ Conduct coverage reviews based on individual member plan benefits and national and proprietary coverage review policies, render coverage determinations
+ Document clinical review findings, actions, and outcomes in accordance with policies, and regulatory and accreditation requirements
+ Engage with requesting providers as needed in peer-to-peer discussions
+ Be knowledgeable in interpreting existing benefit language and policies in the process of clinical coverage reviews
+ Participate in daily clinical rounds as requested
+ Communicate and collaborate with network and non-network providers in pursuit of accurate and timely benefit determinations for plan participants while educating providers on benefit plans and medical policy
+ Communicate and collaborate with other internal partners
You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
**Required Qualifications:**
+ M.D. or D.O.
+ Active unrestricted license to practice medicine
+ Board certification approved by the AMBS or AOBMS specialty
+ 5+ years of clinical practice experience after completing residency training
+ Proven sound understanding of Evidence Based Medicine (EBM)
+ Demonstrated PC skills, specifically using MS Word, Outlook, and Excel
**Preferred Qualifications:**
+ Board certified Surgeon or OBGYN
+ Compact License
+ Experience in utilization review
+ Demonstrated data analysis and interpretation aptitude
+ Proven innovative problem-solving skills
+ Proven excellent presentation skills for both clinical and non-clinical audiences
+ Demonstrated excellent oral, written, and interpersonal communication skills, facilitation skills
*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
Compensation for this specialty generally ranges from $238,000 - $357,500. Total cash compensation includes base pay and bonus and is based on several factors including but not limited to local labor markets, education, work experience and may increase over time based on productivity and performance in the role. We comply with all minimum wage laws as applicable. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives.
**Application Deadline:** This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.
_At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission._
_UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations._
_UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment._

Job Title: Full-Time Medical Assistant

Company Overview: ExpressCare Urgent Care Centers is a well-established and fast-growing urgent care company in Maryland, committed to providing high quality healthcare to our community. An ideal applicant is a self-motivated and compassionate healthcare worker who thrives in a fast-paced environment while supporting our providers and ensuring a smooth patient experience while providing excellent care. Join our team as a Medical Assistant and play a vital role in delivering high-quality patient care to our community! We currently have immediate openings at our Mt. Airy location- 504 East Ridgeville Blvd, Suite 102 Mt. Airy Maryland 21771.

Job Responsibilities:

• Medical history intake: Perform a detailed triage and accurately document patient information in the electronic medical record (EMR)

• Vital sign measurement: Measure and record blood pressure, heart rate, temperature, and height/weight
• Basic lab procedures: Perform simple laboratory tests such as EKGs, phlebotomy, urine specimen collection, and influenza nasal swabs
• Medication administration: Prepare and administer oral and injectable medications under physician supervision
• Exam room preparation: Setup exam rooms with necessary instruments and supplies
• Patient Education: Provide patients with basic health information and instructions regarding discharge papers and medications given by the provider
• Administrative tasks: Accurately complete checklists, inventory, and other written logs

Minimum Requirements:

• Education:

1. Completion of an accredited Medical Assistant program and clinical externship (Required)

• Licenses & Certifications:

1. CMA, RMA, or CCMA Certification preferred
2. CPR Certification (Required)

• Work Experience:

1. Minimum one year of clinical experience in a physician's office or hospital (preferred)

• Required Skills, Knowledge, and Abilities

1. Knowledge of medical terminology
2. Superior customer service skills
3. A high level of professionalism
4. Effective written and verbal communication skills
5. Willingness to comply with the company travel policy
6. Ability to work 12+ hour shifts, stand/walk for long periods, and lift 25 lbs.
7. Must have scheduling flexibility, including weekends and holidays

Pay & Benefits:

• Competitive hourly pay: $17 - $23 based on education and years of experience, plus opportunities for overtime
• Full benefits package, including PTO, SSL, and 7 premium pay holidays when worked
• Health, dental, and vision insurance (single and family coverage) available 30 days after full time employment
• 401(k) plan with company match after one year
• Exciting opportunities for growth within the organization

If you're passionate about patient care and looking for a rewarding career with growth potential, we'd love to hear from you! Apply today to join the ExpressCare team!

Job Title:  Full-Time Medical Assistant

Company Overview: ExpressCare Urgent Care Centers is a well-established and fast-growing urgent care company in Maryland, committed to providing high quality healthcare to our community.  An ideal applicant is a self-motivated and compassionate healthcare worker who thrives in a fast-paced environment while supporting our providers and ensuring a smooth patient experience while providing excellent care. Join our team as a Medical Assistant and play a vital role in delivering high-quality patient care to our community! We currently have immediate openings at our Mt. Airy location- 504 East Ridgeville Blvd, Suite 102 Mt. Airy Maryland 21771. 

Job Responsibilities:

• Medical history intake:   Perform a detailed triage and accurately document patient information in the electronic medical record (EMR)

• Vital sign measurement:  Measure and record blood pressure, heart rate, temperature, and height/weight
• Basic lab procedures:  Perform simple laboratory tests such as EKGs, phlebotomy, urine specimen collection, and influenza nasal swabs
• Medication administration:  Prepare and administer oral and injectable medications under physician supervision
• Exam room preparation: Setup exam rooms with necessary instruments and supplies
• Patient Education:  Provide patients with basic health information and instructions regarding discharge papers and medications given by the provider 
• Administrative tasks:  Accurately complete checklists, inventory, and other written logs

Minimum Requirements:

• Education:

1. Completion of an accredited Medical Assistant program and clinical externship (Required)

• Licenses & Certifications:

1. CMA, RMA, or CCMA Certification preferred
2. CPR Certification (Required)

• Work Experience:

1. Minimum one year of clinical experience in a physician’s office or hospital (preferred)

• Required Skills, Knowledge, and Abilities

1. Knowledge of medical terminology
2. Superior customer service skills
3. A high level of professionalism
4. Effective written and verbal communication skills
5. Willingness to comply with the company travel policy
6. Ability to work 12+ hour shifts, stand/walk for long periods, and lift 25 lbs.
7. Must have scheduling flexibility, including weekends and holidays

Pay & Benefits:

• Competitive hourly pay: $17 - $23 based on education and years of experience, plus opportunities for overtime
• Full benefits package, including PTO, SSL, and 7 premium pay holidays when worked
• Health, dental, and vision insurance (single and family coverage) available 30 days after full time employment
• 401(k) plan with company match after one year
• Exciting opportunities for growth within the organization

If you’re passionate about patient care and looking for a rewarding career with growth potential, we’d love to hear from you! Apply today to join the ExpressCare team!