Jobs in Delafield Wisconsin Remote
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Job Description The Manager of Physician Compensation & Productivity supports the Director in managing the compensation review and reconciliation process across all medical groups, including those under HHP.
This position maintains and assists in making recommendations related to physician compensation plans.
The Manager provides leadership and proficiency on physician compensation matters.
Remote working/work at home options are available for this role.
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.
Remote working/work at home options are available for this role.
Become a part of our caring community and help us put health first The Medical Director relies on medical background and reviews health claims.
The Medical Director work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.
Remote working/work at home options are available for this role.
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.
Remote working/work at home options are available for this role.
Prisma Health, the largest not-for-profit healthcare provider in South Carolina, seeks talented board-certified Emergency Physicians and fellowship-trained subspecialists to both teach and practice in the Department of Emergency Medicine, University of South Carolina School of Medicine Greenville.
Our Department of Emergency Medicine provides episodic care to more than 350,000 patients annually across seven emergency departments. The Prisma Health Department of Emergency Medicine boasts more board-certified Emergency physicians than any other Department in the state, more subspecialty fellowship trained Emergency Physicians than any other Department in the state, and the Upstate?s only Emergency Medicine residency program (PGY 1-3, accepting 10 residents per year), which is the 3rd largest residency program in the institution. Assistant Medical Directorships are available as well.
Actively recruiting for:
Academic Emergency Medicine Faculty Emergency Physicians with fellowship training in: Critical Care Medicine Medical Toxicology Pediatric Emergency Medicine Division Chief of Pediatric Emergency Medicine
Details:
- Accredited 3-year Emergency Medicine Residency Program Level 1 Trauma Center Dedicated Pediatric Emergency Department within the Children?s Hospital Six Community Hospital Emergency Departments Accredited Chest Pain, STEMI, and Comprehensive Centers Pediatric Intensive Care Unit and Neonatal Intensive care Unit Medical Toxicology program Dedicated Divisions of Emergency Psychiatry, Medical Education, Pediatric Emergency Medicine, Prehospital Medicine, Resuscitation and Critical Care, and Ultrasound Regional ground and air EMS System leadership Advanced Emergency Ultrasound Fellowship Medical Education, Technology, and Design Fellowship
Highlights:
- Competitive salary, variable compensation, and professional expense allowance
Paid relocation and malpractice with tail coverage Generous benefits including disability, life, retirement, health, dental, and vision coverage. Public Service Loan Forgiveness Employer With nearly 30,000 team members, 18 hospitals, 2,984 beds, and more than 300 physician practice sites, Prisma Health serves more than 1.2 million unique patients annually. Its goal is to improve the health of all South Carolinians by enhancing clinical quality, the patient experience, and access to affordable care, as well as conducting clinical research and training the next generation of medical professionals.
Greenville, South Carolina is a beautiful place to live and work in a catchment area of 1.3 million people. Greenville is located on the I-85 corridor between Atlanta and Charlotte and is one of the fastest-growing areas in the country. Ideally situated near beautiful mountains, beaches, and lakes, we enjoy a diverse and thriving economy, and excellent quality of life, with wonderful cultural and educational opportunities.
Candidates should submit a letter of interest and CV to: Darian Lyles, Physician Recruiter, .
Prisma Health is an equal-opportunity employer which proudly values diversity. Candidates of all backgrounds are encouraged to apply.
Remote working/work at home options are available for this role.
Become a part of our caring community and help us put health first The Medical Director relies on medical background and reviews health claims.
The Medical Director work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.
Remote working/work at home options are available for this role.
Summary:
- The Medical Director provides timely expert medical review of medical necessity requests for clinical services that do not meet utilization review criteria and renders a clinical opinion about the medical service under review while located in a state or territory of the United States.
Responsibilities include:
- Provide timely expert medical review of medical necessity requests for clinical services related to post-acute care and render a clinical opinion about the medical service under review, including post-decision reviews.
- Provide timely and collegial peer-to-peer discussions with treating physicians to clarify clinical information and to explain review outcome decisions.
- Participate in proactive peer to peers to assist with appropriate and timely discharge planning.
- Document all actions related to clinical review sessions and attest to review qualifications as required.
- Conduct weekly Case Conferences with nursing and social worker teams; discussing every assigned member receiving care in a post-acute care facility, focusing on discharge planning, complex medical care management, quality of care, appropriate level of care, and appropriate length of stay.
- Maintain necessary credentials and immediately inform eviCore of any adverse actions relating to medical licenses and/or board certifications.
- Support the review of eviCore clinical guidelines.
- Support and communicate eviCore policies and procedures to the provider community.
- Testify at ALJ Hearings when your cases are being appealed
- Assist with staff educational training and in-service programs and serve as a clinical resource for eviCore staff.
- Serve as a Subject Matter Expert when Medical Directors and/or Senior Medical Directors are unavailable.
- Available for scheduled weekend call from home based on business needs.
- Participate in Joint Operating Committee (JOC) meetings, including the collection and review of data relevant to the client, and other virtual events with the provider engagement team in your specified territory.
- Participate in all required educational and quality improvement activities and maintain passing scores in all assessments.
- Assist in reviewing case determinations from clients responding to a provider or member complaint
- Maintain necessary credentials and immediately inform eviCore of any adverse actions relating to medical licenses and/or board certifications
- Other duties as assigned
Minimum Education, Licensure and Professional Certification requirement:
- M.D or D.O with active board certification in primary care specialties (Family Medicine, Internal Medicine or Emergency Medicine) OR board certification in Physical Medicine and Rehabilitation required (recognized by the American Board of Medical Specialties or American Osteopathic Association) ?
- Three (3) or more years of relevant clinical practice post residency/fellowship required
- Active unrestricted license to practice medicine in a state or territory of the United States as a utilization review Doctor of Medicine or Doctor of Osteopathic Medicine.
- Knowledge of applicable state and federal laws, URAC and NCQA standards, and utilization management
- Ability to commit to a set, weekly work schedule (Monday through Friday)
- Strong computer skills: ability to work autonomously with automated processes, computer applications, and systems
- Meet physical demands of the role including, but not limited to, typing, speaking, and listening 100% of the time
- In accordance with our HITECH Security Accreditation, company provided encrypted-workstation is required to be hard-wire connected to a modem or router. Wireless connection is not permitted.
This role is also anticipated to be eligible to participate in an annual bonus 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 Evernorth Health Services
Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. 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.
Remote working/work at home options are available for this role.
Located in Hershey, PA, Milton Hershey School (MHS) is a top-notch home and school where over 2,200 pre-K through 12th grade students from disadvantaged backgrounds are provided an extraordinary, cost-free, career-focused education. This is made possible by the generosity of Milton and Catherine Hershey, who established the school in 1909 and ensured it was fully endowed. Thanks to their foresight and generosity, the school has over 12,000 graduates and continues to expand to serve more students.
MHS is hiring married couples to serve as Full-time Flex Houseparents. In this unique and life-changing career, couples reside in on-campus student homes and provide care, guidance, supervision, and support for a group of approximately 8–13 students living in the home. Flex Houseparents play a vital role in creating a structured, family-like environment that fosters students’ academic, emotional, and social development so they can reach their full potential.
Responsibilities include:
Providing daily supervision and mentorship
Managing household routines and student schedules
Administering medications and ensuring student wellness
Driving students to activities, as well as planning and actively engaging in developmental and recreational activities with students
Leading daily devotions and accompanying students to Sunday Chapel
Overseeing budgeting and household reporting
Upon hire, Flex Houseparents initially support various student homes and follow a working schedule of nine consecutive days on duty, followed by three days off. On weekdays, houseparents have unscheduled time while students are in school. Flex Houseparents eventually transition into a Placed Houseparent role, where they live and work with the same group of students in their own student home.
Benefits include:
Salary: $44,768.00 per person (approximately $168,000 total compensation per couple, including free housing, meals while on duty, utilities, and more)
Comprehensive benefits: medical, dental, and vision insurance; health savings and flexible spending accounts; life insurance; disability options; retirement savings
Relocation assistance and paid training provided
~ Paid time off provided at designated times throughout the year
Qualifications:
Qualifications include:
Experience working or volunteering with youth
This is a two-person role for couples legally married for at least two years
Both spouses must be age 27 or older
No more than three dependent children may reside in the student home
Commitment to a smoke-free and weapon-free campus; no alcohol permitted while on duty
Pet limitations: only fish and one dog of approved breeds allowed
Valid U.S. driver’s license and ability to become certified to drive student home vans
Comfort leading students in daily devotions and accompanying them to Judeo-Christian Sunday Chapel services (proselytizing prohibited)
High school diploma or GED required
Ability to lift to 50 lbs.
Demonstrated integrity and professionalism; MHS staff serve as role models for students
This is a unique, challenging, and rewarding career and life choice that requires a high level of commitment to student success from both spouses. For consideration, both spouses must complete individual employment applications. To learn more and apply, visit
.
Remote working/work at home options are available for this role.
Shift Start Time:
Variable
Shift End Time:
Variable
AWS Hours Requirement:
8/40 - 8 Hour Shift
Additional Shift Information:
Weekend Requirements:
As Needed
On-Call Required:
Yes
Hourly Pay Range (Minimum - Midpoint - Maximum):
$124.640 - $160.830 - $197.020
The stated pay scale reflects the range that Sharp reasonably expects to pay for this position. The actual pay rate and pay grade for this position will be dependent on a variety of factors, including an applicant’s years of experience, unique skills and abilities, education, alignment with similar internal candidates, marketplace factors, other requirements for the position, and employer business practices.
What You Will Do
Working with the Chief Medical Officer, oversees medical care for Sharp Health Plan (SHP) products and services and oversees the health care needs of the membership. Serves as a medical manager and policy advisor to SHP and its Chief Medical Officer. Is accountable for and provides professional leadership and direction to the utilization/cost management and clinical quality management functions. Works collaboratively with other plan functions that interface with medical management such as provider relations, member services, benefits and claims management, etc. Assists (as determined by the plan Chief Medical Officer) in short and long range program planning, total quality management (quality improvement), and external relationships. Works with all departments of Health Services to support, provide assistance and direction in overall medical management effectiveness. Reports all issues of clinical quality management to the health plan Chief Medical Officer. To ensure that policies and systems are followed until agreed upon change is implemented. Works toward SHP strategic goals and objectives of ensuring a high quality of medical care for Plan members, staff empowerment, customer satisfaction, cost-effectiveness, and market competitiveness. As a member of the management team, assists in identifying and establishing strategic goals and objectives for the Plan.
Required Qualifications
- Doctor of Medicine (MD)
- Previous experience in the clinical practice of medicine.
- Previous experience as a physician executive in a managed care environment, preferably as an HMO Medical Director.
- California Physicians and Surgeons License - Medical Board of CA -REQUIRED
Other Qualification Requirements
- Board certified in a medical discipline (internal medicine or family practice preferred).
Essential Functions
- Responsible and accountable to the Chief Medical Officer for helping to manage health plan medical costs and assuring appropriate health care delivery for SHP's products and services. Reports organizationally to the Chief Medical Officer.
- Plans, organizes, and directs the professional medical services program, consisting of all primary and Specialty services for in-patient, out-patient, preventive and wellness programs.
- Implements health plan medical policies, goals and objectives.
- Provides professional leadership and direction to the functions within the Medical Management
- Department (Utilization/Cost Management and Quality Management)
- Responsible for and assists with the development of staffing plans and assuring the adequate allocation of resources to the medical management functions.
- Responsible and accountable for implementing the Utilization/Cost Management Program and Quality Improvement Program, in conjunction with the Manager Medical Management and Quality Improvement Manager.
- Assists the Chief Medical Officer with activities to promote positive community relations.
- Assures plan conformance with legal and regulatory requirements
- Assists the Chief Medical Officer and the Quality Improvement Manager in creating and maintaining a system that gives feedback to providers individually and collectively regarding managed care effectiveness of individual providers and networks.
- Assists the Chief Medical Officer in designing and implementing corrective action plans to address issues and improve plan and network managed care performance.
- Collaborates with Chief Medical Officer in creating and maintaining programs that incentivize providers to achieve selected utilization/cost and quality outcomes.
- Participates in policy review, performs analysis and makes recommendations.
- Participates in the retrospective review and analysis of Plan performance from summary data of paid claims, encounters, authorization logs, complaint and grievance logs and other sources.
- Achieves and maintains benchmarked utilization and cost management (UM) goals and clinical quality improvement (QI) objectives, in conjunction with the Manager Medical Management and Quality Improvement Manager.
- Provides periodic written and verbal reports and updates as required in program descriptions, Annual Work Plans and policy and procedures to various plan committees, and the SHP Chief Medical Officer.
- Supports NCQA qualification activities. Prepares for site visits and responds to accrediting and regulatory agency feedback.
- Supports pre-admission review, utilization management, and concurrent and retrospective rev1ew process.
- Participates in risk management, pharmacy utilization management, catastrophic case review, outreach programs, HEDIS reporting, site visit review coordination, triage, provider orientation, credentialing, profiling, etc.
- Conducts quality improvement and outcomes studies as directed by the Quality Management Committee, Peer Review Committee and Chief Medical Officer and reports findings in conjunction with the Quality Improvement Manager.
- Participates in the grievance process with the Chief Medical Officer, insuring a fair outcome for all members.
- Monitors member and provider satisfaction survey results and implements changes as needed to increase satisfaction and assure that satisfactory relationships are maintained between network and plan participants.
- Participates in SHP Advisory Committees which include (but are not limited to) the Peer Review Committee and the Quality Management Committee.
- Participates in key marketing activities and presentations, as requested.
- Promotes wellness and ensures programs of prevention, education and outreach to members and providers are consistent with SHP's mission, vision and values.
- Maintains up-to-date knowledge of new information and technologies m medicine and their application to SHP.
- Performs and oversees in-service staff training and education of professional staff.
- Represents SHP at medical group meetings, conferences, etc.
- Participates in the development of strategic planning for existing and expanding business. Recommends changes in program content in concurrence with changing markets and technologies.
- Participates in key marketing activities and presentations, as necessary, to assist the marketing effort, as requested.
- Ensures that the Utilization Management staff is available on a 24 hour basis to respond to authorization requests for emergency and urgent services and is available, at a minimum, during normal working hours for inquiries and authorization requests for non-urgent health care services..
- Performs other duties as requested or assigned.
- Collaborates with the Manager, Medical Management to guide and direct staff in relation to medical issues and departmental responsibilities. Assists in monitoring, reviewing, and evaluating the quality of health care services provided and the appropriateness of health care resources utilized, and communicates with PMGs and Plan providers as needed. Addresses physicians' issues and educates providers with regard to Plan policy as needed.
- Completes and/or supervises the completion of all clinical appeals and grievances. Collaborates with Customer Care Manager to identify trends in grievances. Supervises the process for identifying Potential Quality Issues.
- Supervises Physician Reviewer(s)
- Shares after-hours coverage responsibilities with other physicians
- Assists the CMO, as needed, to oversee the credentialing process.
- Assists in the development and interpretation of the covered benefit provisions of member materials and Plan contracts. Assists in the development and implementation of new benefits packages.
- Maintains appropriate contacts with membership in community and professional organizations.
Knowledge, Skills, and Abilities
- Strong clinical background and skills.
- Solid understanding of utilization management and quality assurance activities and concepts.
- Excellent communication skills, both verbal and written.
- Strong interpersonal skills, including the ability to interface effectively with employees, members, physicians, senior management, and the public at large.
- Management skills to meet the organizational goals.
- Knowledge of regulatory and accreditation agencies and requirements.
- Able to manage multiple priorities and deadlines in an expedient and decisive manner.
- Able to manage difficult peer situations arising from medical care review.
- Appreciation of cultural diversity and sensitivity towards target population.
Sharp HealthCare is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender, gender identity, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified individual with disability or any other protected class
California Physicians and Surgeons License - Medical Board of CA; Doctor of Medicine (MD)
Powered by SonicJobs (an advertiser on Veritone). By applying, you consent to share your data with SonicJobs and the employer. Veritone or SonicJobs does not store or use your application data beyond facilitating the application.
See Sharp HealthCare Terms & Conditions at and Privacy Policy at and SonicJobs Privacy Policy at and Terms of Use at Category:Healthcare, Keywords:Medical Director, Location:San Diego, CA-92108
Remote working/work at home options are available for this role.
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Licensed Mental Health Counselor (LMHC)
Wage: Between $120-$131 an hour
Licensed Mental Health Counselor — Are you ready to launch or expand your private practice? Headway is here to help you start accepting insurance with ease, increase your earnings with higher rates, and start taking covered clients sooner. It’s all on one free-to-use platform, no commitment required.
About you
● You’re a fully-licensed Mental Health Counselor at a Master’s level or above with LMHC, LPCMH, or LIMHP licensure (accepted on a state by state basis), a valid NPI number, and malpractice insurance.
● You’re ready to launch a private practice, or grow your existing business by taking insurance.
About Headway
Your expertise changes lives. Taking insurance makes it accessible to those who need it most. Every mental health provider who goes in-network with Headway supports people who’d otherwise be forced to choose between paying out of pocket, or not getting care at all. We make that process seamless — empowering you to accept insurance with ease, so you can do what you do best. So far, we’ve helped over 50,000 providers grow their practices, reaching countless people in need.
How Headway supports providers
- Start taking insurance, stress-free: Get credentialed for free in multiple states in as little as 30 days and start seeing covered clients sooner.
- Built-in compliance: Stay compliant from day one with audit support and ongoing resources.
- Expansive coverage: Work with the plans that most clients use, including Medicare Advantage and Medicaid.
- Increase your earnings: Secure higher rates with top insurance plans through access to our nationwide insurance network.
- Dependable payments: Build stability in your practice with predictable bi-weekly payments you can count on.
- Built-in EHR features: Manage your practice in one place with real-time scheduling, secure client messaging, end-to-end documentation templates, built-in assessments, and more.
- Free continuing education: Nurture your long-term professional goals and earn CEUs with complimentary courses on Headway Academy.
How Headway supports your clients
● Increased access: Headway makes it easier for your clients to get the care they need at a price they can afford through insurance.
● Instant verification: Clients can easily check their insurance status and get the care they need without disruption.
Please note: At this time, Headway can’t support mental health professionals that aren’t fully licensed. If your application was rejected for incomplete licensure, you’re welcome to reapply once you have a valid license.
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Keywords:
mental health counseling, licensed counselor, private practice, insurance credentialing, client care, telehealth, therapy, behavioral health, practice management, continuing education
Remote working/work at home options are available for this role.
