Director of Medical Reviews Job at Healthfirst (New York)

Medical Director of Case Management and Utilization Review

The Medical Director of Case Management and Utilization Review leads the hospita...

Location

United States , Miramar

Salary:

Not provided

Memorial Healthcare System

Expiration Date

Until further notice

Requirements

Medical Doctor (Required)
Medical Doctor License (ME LICENSE) - State of Florida (FL)
Osteopathic Physician License (OS LICENSE) - State of Florida (FL)
Extensive experience in one or more branches of medicine or surgery
at least, five (5) post-training years of medical staff organization/administrative experience in a large acute care hospital
Graduate of a medical school approved by the Council on Medical Education of the American Medical Association
Excellent customer service and interpersonal skills
Able to effectively present information, both formal and informal
Strong written and verbal communications skills with all levels of internal and external customers
Strong analytical skills

Job Responsibility

Supports education and clinical documentation improvement
Leads Complex Care Management
Leads hospital initiatives to reduce complex patient length of stay
Makes decisions on referred individual patient cases regarding pre-admission authorization, medical necessity and services/setting, appropriateness of admission, and continuation stay
Provides peer review services for medical necessity of admission or continued stay
Supports the Senior Medical Director in Medical Staff Education
Assists physicians in improving the quality of their medical necessity documentation
Serves as liaison to insurance companies for prior authorizations and removes barriers to discharge
Supports case management by attending interdisciplinary rounds (IDR) and provides feedback and suggestions to physicians and CMs
Serves as liaison to case management, social workers, nursing staff, individual physicians, and the medical staff

Fulltime

Medical Director of Population Health

The Medical Director of Population Health plays a strategic role in improving ut...

Location

United States , Macon

Salary:

Not provided

Advocate Health Care

Expiration Date

Until further notice

Requirements

License/Registration/Certification: Appropriate State Physician License
Certification: Appropriate board certification by American Board of Medical Specialties
Minimum of 7 years experience in the clinical practice of medicine
Minimum of 3 years experience in medical management or academic medicine
Exhibits a high level of professionalism, personal integrity, fortitude and approach to problem-solving
Models exemplar leadership behaviors
Possesses exceptional written and verbal communication and interpersonal skills
Committed to service of patients, colleagues and team members
Demonstrates strong leadership and effective team-building skills
Skilled in the ability to conduct difficult conversations, while effectively coaching and mentoring colleagues

Job Responsibility

Provide leadership and mentorship to Physician members in achieving High Performing Network priorities of quality, efficiency and engagement
Collaborate with EPH teams on quality, CMD, utilization and other performance initiatives
Maintain a close working relationship with stakeholders including aligned PCPs and specialists, SE quality team, medical group leadership including specialty medical directors, site medical directors, primary care service line
Attend, and lead when called on, population health and CGHN meetings concerning quality, utilization, finance, performance, and any administrative meetings as necessary
Identify and develop action plans to address performance improvement gaps within CGHN
Actively engage in financial review and planning for the CGHN finances and value-based lives membership
Identify potential new leaders and collaborate with CGHN leadership on succession planning for CGHN Board and other CGHN committees and activities
The Clinical leader supporting different population health teams supporting CIN physicians within CGHN

What we offer

Paid Time Off programs
Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
Flexible Spending Accounts for eligible health care and dependent care expenses
Family benefits such as adoption assistance and paid parental leave
Defined contribution retirement plans with employer match and other financial wellness programs
Educational Assistance Program

Fulltime

Associate Medical Director, US Medical Affairs

The Associate Medical Director will be responsible for contributing to and parti...

Location

United States , Morristown

Salary:

180000.00 - 210000.00 USD / Year

Alfasigma

Expiration Date

Until further notice

Requirements

MD/PhD/PharmD (or equivalent) with a minimum of 5 years of professional/clinical experience
At least 3 years of biopharmaceutical industry experience in Medical Affairs and/or Clinical Research is required
Experience working with professional societies and quality organizations preferred
Prior experience in Hepatology, Gastroenterology, or Immunology preferred
Ability to travel up to 20% required (mostly to congresses/ad boards), which may include overnight and/or weekend travel
Strong understanding of Medical Affairs functions, processes, and strategic execution
Track record of being held accountable for key individual deliverables with successful results required
Strong verbal and written communication skills are essential, including strong presentation skills
Excellent organization and multi-tasking skills
Strong interpersonal skills and problem-solving capabilities

Job Responsibility

Participate in the development of a cross-functionally aligned set of medical strategies for the US market needs, focused on commercialized as well as late-stage development indications/assets
Develop the strategy for professional medical association engagement in the US in conjunction with other US stakeholders as part of the broader professional society strategy
Support medical affairs data generation and dissemination working group(s) and collaborate with the Scientific Communications team to develop and execute aligned strategies/tactics for maximizing our scientific communication efforts
Support field medical activities and help to assess and address internal/external medical education needs in collaboration with the Field Medical and Scientific Communications teams
Perform scientific and clinical training for internal staff, including Commercial/Sales, on Alfasigma products and respective disease-related aspects
Lead and execute scientific advisory boards to generate strategic insights that inform medical affairs plans
Participate in or perform review of promotional and medical/scientific materials as the Medical Reviewer, following standard operating practices (SOPs) and in collaboration with Regulatory, Legal, and Commercial counterparts
Maintain strong relationships with the external thought leader and influencer communities
Contribute to, and support execution of the lifecycle management activities for Alfasigma’s commercialized indications/assets
Understand the legal and compliance environment and drive collaboration with the Legal and Compliance team

What we offer

401(k) plan with company match
Rewards and recognition program
Health care benefits (medical, prescription drugs, dental, and vision insurance)
Short and long-term disability coverage provided
Plan coverage for domestic partners
Paid parental leave benefits and adoption assistance
Tuition reimbursement assistance
A generous Paid Time Off program that includes 20 vacation days, 11 holidays, 4 personal days, and 2 volunteer days per calendar year
Numerous well-being and work/life programs

Fulltime

Medical Director/Sr Medical Director - Neurology

Join Us as a Medical Director – Make an Impact at the Forefront of Innovation. A...

Location

United States

Salary:

Not provided

myGwork - LGBTQ+ Business Community

Expiration Date

Until further notice

Requirements

MD or equivalent required
Active medical licensure preferred
Clinical experience in treating patients in the specialty or sub-specialty associated with the applicants training (comparable to 2 years), i.e. Neurology Residency/Fellowship
Suitable clinical trial experience in a Contract Research Organization, pharmaceutical company or as a principal investigator (comparable to 1-2 years) in the industry
Direct experience in safety/Pharmacovigilance (comparable to 2 years)
Therapeutic expertise across one or more medical specialty or sub-specialties
Strong decision-making, problem solving, organizational skills and analytical skills
Excellent oral and written communication skills
Working knowledge of relevant safety databases (e.g. Medra)
Flexibility to travel domestically and internationally

Job Responsibility

Manage all medical aspects of contracted tasks across the pharmaceutical product life-cycle
Ensure tasks delegated to PV are properly executed
Adhere to applicable regulations and ICH guidelines regarding clinical trials, regulatory documents, and safety issues
Follow client SOPs/directives and project-specific WPDs for assigned projects
Comply with CRG’s corporate policies and SOPs/WPDs
Provide medical consultation to team members and answer all study-related medical questions
Communicate clearly with associates and clients, maintaining an open line of communication to ensure all procedures are followed appropriately
Provide therapeutic training and protocol training on assigned studies, as requested
Assist in writing (interpretation of safety and efficacy data) and/or reviewing CSR, IND/NDA reports, ICSR, signal detection reports, periodic reports, RMP, REMS, CTD modules, etc., to ensure that the medical content is accurate and complete
Monitor all safety variables (AE, laboratory abnormalities, changes in patient medical status, evaluation of prescribed concomitant medication for protocol restrictions, and un-blinding requests) of clinical studies

Fulltime

Center Medical Director

We’re building a world of health around every individual — shaping a more connec...

Location

United States , Stone Mountain

Salary:

Not provided

CVS Health

Expiration Date

December 31, 2026

Requirements

M.D., D.O., or A.P.N or P.A. graduates
Board certification in Internal Medicine or Family Medicine required for M.D. or D.O., Board certification in Family, Adult, or Gerontology for A.P.N
Experience in clinical leadership roles, leading and coaching providers
Experience using a metrics-driven approach to the provision of medical care and/or quality projects
Commitment to older adults and to low-income patients
Comfort with ambiguity and a love for problem solving
Ability to remain calm in the midst of the storm, guiding others to smart, effective solutions
US work authorization

Job Responsibility

Lead the clinical team at their center in providing the best patient care and a great place to work
Practice primary care in our clinics alongside their provider colleagues at 80% clinical time and 20% administrative time
Set an example for how thoughtful primary care is practiced
Serve as a formal mentor, coach, and advisor to providers in Oak Street clinics
Participate in critical organizational-wide strategic initiatives
Work in tight collaboration with the Practice Manager and Outreach Manager/Director to achieve organizational objectives
Drive implementation of OSH strategic initiatives
Follow direction from regional leadership
Cascade both organizational information to care team members as well as escalate care team concerns and ideas
Help coordinate and lead the onboarding of new providers at the center

What we offer

medical, dental, and vision coverage
paid time off
retirement savings options
wellness programs

Fulltime

Account Management Medical Director RVP

The Regional Vice President, Account Management Medical Director serves in an im...

Location

United States , Woodland Hills; Costa Mesa; Walnut Creek; Denver; Las Vegas; Grand Prairie

Salary:

286000.00 - 514000.00 USD / Year

Elevance Health

Expiration Date

July 17, 2026

Requirements

MD and a minimum of 10 years of progressive industry experience
or any combination of education and experience, which would provide an equivalent background
Current unrestricted medical license in applicable state(s)
Board certification

Job Responsibility

Cultivates relationships with decision-makers and influencers within prospective customers
Serves as a clinical thought leader and develops strategic messaging and partners with Sales RVPs, Account Executives and Account Managers for new sales
Supports account finalist opportunities and client quarterly and annual reviews
Ensures high-quality and efficient medical services are provided to accounts
Serves as the voice of health policy to the clients and consults with and advises them in shaping their decisions around clinical programs and strategy
Serves as a medical subject matter expert in one of several areas to provide counsel and advice on relevant strategies and initiatives
May represent the company on external committees or with applicable vendors as needed
Fosters a culture of continuous improvement and best practice sharing in support of clinical models

What we offer

Comprehensive benefits package
Incentive and recognition programs
Equity stock purchase and 401k contribution
Merit increases
Paid holidays
Paid Time Off
Incentive bonus programs
Medical
Dental
Vision

Fulltime

Director Medical Data Review

At Amgen, if you feel like you’re part of something bigger, it’s because you are...

Location

India , Hyderabad

Salary:

Not provided

Amgen

Expiration Date

Until further notice

Requirements

Master/ Doctorate/ MD with ~ 18 years of Industrial experience
9+ years of experience in life sciences or a medically related field, including significant experience in medical monitoring and/or clinical data review
Prior people management experience with direct reports
Demonstrated strategic leadership of a clinical data review or medical monitoring function
Experience leading clinical trial process improvement and data quality optimization initiatives
Strong communication and presentation skills (written and oral)
Deep understanding of operational aspects of clinical data review
Advanced proficiency with clinical data analysis tools (e.g., Spotfire or equivalent)

Job Responsibility

Define and execute the enterprise-wide vision, strategy, and multi-year roadmap for Medical Data Review (MDR), including operating model, technology enablement, workforce capabilities, and organizational transformation
Lead enterprise transformation initiatives that advance risk-based and technology-enabled clinical oversight, including AI-assisted review, automation, RBQM integration, integrated data review, and predictive risk management
Establish and govern enterprise standards, KPIs, quality benchmarks, and risk thresholds to ensure consistent, high-quality medical data review across the clinical development portfolio
Partner with senior leaders across Therapeutic Areas, Clinical Operations, Data Management, Safety, and Digital functions to drive strategic alignment and resolve enterprise-level trade-offs involving quality, timelines, cost, and risk
Establish and lead governance frameworks that provide oversight of clinical data review strategy, quality performance, risk management, and continuous improvement across the organization
Provide strategic leadership for the global MDR organization, including organizational design, resource planning, capability development, and scalable operating models that support diverse clinical programs
Drive operational excellence and trial delivery predictability through proactive performance management, data-driven decision-making, and standardized yet flexible review frameworks
Evaluate emerging industry trends and translate innovations into practical enterprise capabilities that improve quality, efficiency, and risk management
Own the enterprise inspection readiness strategy for clinical data quality, ensuring robust review traceability, regulatory compliance, proactive risk mitigation, and executive-level issue escalation
Champion innovation through the adoption and scaling of advanced analytics, AI/ML-enabled capabilities, predictive risk modeling, and integrated review technologies that transform insights into business outcomes

Fulltime

Assistant Director of Nursing

We are currently recruiting for an Assistant Director of Nursing to join the tea...

Location

Ireland , Rathluirc (Charleville)

Salary:

Not provided

Mowlam Healthcare

Expiration Date

Until further notice

Requirements

First level registration
Registered on appropriate part of NMBI live register
Evidence of continuous Professional Development
Previous management experience
Proven track record in healthcare clinical management
Excellent Leadership, Organisational and Communication skills
Ability to work well and promote a team environment
Willingness to be flexible and adapt to the needs of the company

Job Responsibility

To ensure the delivery of the highest standards of nursing and social care which meet the individual needs of each resident
Ensuring that the home policies and expected clinical standards are read, understood and practiced at all times
Conducting ward rounds (including those with GP) to ensure that the best clinical outcomes are achieved on a continuous basis
Reviewing nursing documentation to ensure this reflects the care and treatment required by each individual resident and that assessments and care plans are completed appropriately within agreed timeframes and reviewed as required
Reviewing residents at increased risk of pressure sores, falls and other adverse events, and those who are clinically unwell, providing advice, support and assistance through clinical practices and documentation so as to ensure appropriate management plan is in place
Participate in handover and help troubleshoot any ongoing clinical issues and non-clinical issues, escalating to the Director of Nursing as appropriate
Ensuring medication practices are carried out according to An Bord Altranais guidelines and as per recommended practice in the nursing home
Ensuring that all nursing staff are deemed competent in all aspects of medication management
Ensuring that education on medication management practices is provided to all newly appointed staff as part of their induction
Undertaking regular MAMS Medicines audits in the centre and ensuring effective feedback and action plans are undertaken and reviewed

Fulltime

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Director of Medical Reviews

Job Description

Job Responsibility

Requirements

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