13 internal medicine physician jobs found

Company : Highmark Inc. Job Description : JOB SUMMARY This job provides front line staff guidance, ensures effective and efficient delivery of Pharmacy call center services. Serves as first line reviewer in monitoring and ensuring adherence to the health plan's state and federal multiple drug benefit design offerings. The incumbent responds to physician and pharmacy network provider inquiries concerning oral, injectable and infusion medication requests, and drug claim edits/prior authorizations. By reviewing member claims history, clearly defines the medical necessity of non-formulary and prior authorization medication exception requests. Interacts with pharmacy network providers to evaluate, educate and/or assist in addressing denied point of sale prescription claim transitions and coordination of benefits practices/procedures. ESSENTIAL RESPONSIBILITIES Communicate effectively with physician and pharmacy network providers to ensure that the needs of the...

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: As a Cardiology, Field Medical Director you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in patients lives, in a...

Become a part of our caring community and help us put health first The Care Manager, Telephonic Nurse utilizes clinical nursing skills to support the coordination, documentation, and communication of medical services and/or benefit administration. The work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. Associate will be expected to participate in weekend rotation a minimum of one hour each on Saturday and Sunday once every 17 weeks. Work schedule can be between 8am-6:30pm EST. The Care Manager Telephonic Nurse uses clinical knowledge, communication skills, and independent critical thinking skills to provide the best and most appropriate treatment, care or services for members. Coordinates and communicates with providers, members, or other parties to facilitate optimal care and treatment. Understands department, segment, and organizational strategy and operating objectives, including their...

Bring more to life. Are you ready to accelerate your potential and make a real difference within life sciences, diagnostics and biotechnology? At Aldevron, one of Danaher’s 15+ operating companies, our work saves lives—and we’re all united by a shared commitment to innovate for tangible impact. You’ll thrive in a culture of belonging where you and your unique viewpoint matter. And by harnessing Danaher’s system of continuous improvement, you help turn ideas into impact – innovating at the speed of life. At Aldevron, we deliver world-class CDMO services that accelerate the development of groundbreaking therapies. Our mission is to be the engine of innovation for genomic medicine pioneers . As a member of our team, you’ll help bring life-changing innovations to life—impacting millions around the world. We bring together deep scientific expertise, an unwavering commitment to quality, and a collaborative spirit to drive progress. Whether you're launching your career or bringing...

At Johnson & Johnson, we believe health is everything. Our strength in healthcare innovation empowers us to build a world where complex diseases are prevented, treated, and cured, where treatments are smarter and less invasive, and solutions are personal. Through our expertise in Innovative Medicine and MedTech, we are uniquely positioned to innovate across the full spectrum of healthcare solutions today to deliver the breakthroughs of tomorrow, and profoundly impact health for humanity. Learn more at https://www.jnj.com Job Function Medical Affairs Group Job Sub Function Professional Medical Education Job Category People Leader All Job Posting Locations: Albuquerque, New Mexico, United States of America, Albuquerque, New Mexico, United States of America, Anchorage, Alaska, United States, Atlanta, Georgia, United States, Baton Rouge, Louisiana, United States, Boise, Idaho, United States, Boston, Massachusetts, United States of America, Burlington, Vermont,...

Lensa is a career site that helps job seekers find great jobs in the US. We are not a staffing firm or agency. Lensa does not hire directly for these jobs, but promotes jobs on LinkedIn on behalf of its direct clients, recruitment ad agencies, and marketing partners. Lensa partners with DirectEmployers to promote this job for Humana. Clicking "Apply Now" or "Read more" on Lensa redirects you to the job board/employer site. Any information collected there is subject to their terms and privacy notice. Become a part of our caring community and help us put health first The Care Manager, Telephonic Nurse 2 employs a variety of strategies, approaches and techniques to manage a member's physical, environmental and psycho-social health issues. Identifies and resolves barriers that hinder effective care. Ensures patient is progressing towards desired outcomes by continuously monitoring patient care through assessments and/or evaluations. The first 4 weeks of training will be from...

Become a part of our caring community and help us put health first The Associate Director, Finance Data Management supports all aspects of configuration control, data management, and deficiency reporting. The Associate Director, Finance Data Management requires a solid understanding of how Finance organization data capabilities interrelate across department(s). The Associate Director, Finance Data Management supports implementation of government and industry policies for requirements management, document management, change management, production and delivery, and configuration management of the performance, functional, and physical baselines. Acquires, validates, stores, protects, and processes required data to ensure the accessibility, reliability, and timeliness of the data for its users. Develops and executes architecture, policies, practices and procedures that properly manage the full data lifecycle needs of an enterprise. Decisions are typically related to identifying...

Summary This position is in the Health Information Management (HIM) section of the Health Administration Service at the Fargo Health Care System. The Medical Records Technician (Coder) is responsible for abstracting medical record data and assigning codes using current clinical classification systems appropriate for the type of care provided. This job is open to The public U.S. Citizens, Nationals or those who owe allegiance to the U.S. Internal to an agency Current federal employees of the hiring agency that posted the job announcement. Clarification from the agency All US Citizens are eligible to apply to this vacancy. Qualified applicants will be referred in the following order: 1. Current permanent employees of the Fargo VAHCS; 2. Current permanent VHA employees; 3. Current permanent employees of other Federal Agencies and US Citizens The 2-page Resume requirement does not apply to this occupational series. For more information,...

At Prime Therapeutics (Prime), we are a different kind of PBM, with a purpose beyond profits and a unique ability to connect care for those we serve. Looking for a purpose-driven career? Come build the future of pharmacy with us. Job Posting Title Senior Compliance Analyst - Remote Job Description The Senior Compliance Analyst assists in the implementation of Prime's compliance programs and leads initiatives within their designated areas. This role partners with key internal stakeholders to execute compliance program and compliance department activities related to demonstrating compliance program effectiveness through compliance hotline inquiry management and investigations, compliance education and communications, governance reporting, as well as executing program effectiveness self-assessments and data-driven reporting or dashboards. Responsibilities Executes compliance procedures and enforces policy governance across the organization to validate...

Our mission is to detect cancer early, when it can be cured. We are working to change the trajectory of cancer mortality and bring stakeholders together to adopt innovative, safe, and effective technologies that can transform cancer care. We are a healthcare company, pioneering new technologies to advance early cancer detection. We have built a multi-disciplinary organization of scientists, engineers, and physicians and we are using the power of next-generation sequencing (NGS), population-scale clinical studies, and state-of-the-art computer science and data science to overcome one of medicine's greatest challenges. GRAIL is headquartered in Menlo Park, California, with locations in Washington, D.C., North Carolina, and the United Kingdom. It is supported by leading global investors and pharmaceutical, technology, and healthcare companies. For more information, please visit grail.com . The role assists with regulatory strategy and the development of submissions in...

Become a part of our caring community and help us put health first The IHWA Follow-up Senior Program Delivery Professional provides daily operational support to programs that impact members' lives by promoting preventive health activities. The IHWA Follow-up Senior Program Delivery Professional works on problems of diverse scope and complexity ranging from moderate to substantial. Location: remote or strong preference for hybrid in Waterside Louisville, KY office The IHWA Follow-up Senior Program Delivery Professional provides daily operational support to the rapidly expanding In-home Health Well-being Assessment (IHWA) PCP Follow-up program that ensures members follow-up with a PCP and complete essential preventive activities (e.g. mammogram, flu vaccine, colonoscopy) which directly supports our members' care management. The operational support includes being initial person for vendor feedback/questions, delivering routine program reporting, reviewing outreach calls to...

Sumitomo Pharma Co., Ltd., is a global pharmaceutical company based in Japan with operations in the U.S. (Sumitomo Pharma America, Inc.), focused on addressing patient needs in oncology, urology, women's health, rare diseases, cell & gene therapies and CNS. With several marketed products and a diverse pipeline of early- to late-stage investigational assets, we aim to accelerate discovery, research, and development to bring novel therapies to patients sooner. For more information on SMPA, visit our website https://www.us.sumitomo-pharma.com or follow us on LinkedIn. Job Overview We are currently seeking a dynamic, highly motivated, and experienced individual for the position of Senior Manager, Commercial Manufacturing and Packaging. The Sr. Manager, Commercial Manufacturing and Packaging, is responsible for overseeing crucial manufacturing production and ensures uninterrupted supply of SMPA's commercial Oral Solid Dosage (OSD) portfolio through successful execution...

Sumitomo Pharma Co., Ltd., is a global pharmaceutical company based in Japan with operations in the U.S. (Sumitomo Pharma America, Inc.), focused on addressing patient needs in oncology, urology, women's health, rare diseases, cell & gene therapies and CNS. With several marketed products and a diverse pipeline of early- to late-stage investigational assets, we aim to accelerate discovery, research, and development to bring novel therapies to patients sooner. For more information on SMPA, visit our website https://www.us.sumitomo-pharma.com or follow us on LinkedIn. Job Overview The Associate Director, Commercial Drug product Manufacturing and Packaging is responsible for overseeing crucial manufacturing production and ensures uninterrupted supply of SMPA's commercial Oral Solid Dosage (OSD) portfolio through successful execution of production campaigns within our global network of external contract development & manufacturing organizations (CDMOs). This role will...