9 partner relations manager jobs found

Job Description: Summary: The Senior Medical Director is a strategic clinical and business leader responsible for advancing the health plan's line of business focus through value-based care, population health, medical management, quality improvement, risk adjustment, product design, and clinical transformation. This role partners closely with line of business leadership, network and provider contracting, actuarial, finance, quality, pharmacy, analytics, care management, and operations to improve clinical outcomes, member experience, provider performance, and total cost of care while ensuring compliance with CMS requirements. Essential Accountabilities: Serve a senior clinical advisor to line of business leadership on strategy, population health, medical cost, quality, and regulatory priorities, develop and execute clinical strategy in alignment with organizational growth, quality, and financial objectives. Identify clinical and market opportunities to improve member...

Job Description: Summary: This position is responsible for and participates in a wide range of provider, patient, and employer initiatives and programs. The pharmacist supports all of our lines of business which include Medicare, Commercial, Exchange (Marketplace) and Medicaid. The focus of the UM Pharmacist is to manage the quality, appropriateness, safety and cost of medications for our members through the medical management of drugs across our pharmacy and medical benefits. Essential Accountabilities: Level I Conducts drug prior authorization, exception and medical necessity reviews. Works with requesting providers or internal staff to determine whether the submitted clinical information and patient presentation meet the criteria for approval according to the drug policy, formulary availability, and specific coverage criteria. Conducts first line appeal and grievance reviews for medical and pharmacy drugs in accordance with compliance standards. Conducts...

Job Description: Summary: The Senior Medical Director is a strategic clinical and business leader responsible for advancing the health plan's line of business focus through value-based care, population health, medical management, quality improvement, risk adjustment, product design, and clinical transformation. This role partners closely with line of business leadership, network and provider contracting, actuarial, finance, quality, pharmacy, analytics, care management, and operations to improve clinical outcomes, member experience, provider performance, and total cost of care while ensuring compliance with CMS requirements. Essential Accountabilities: Serve a senior clinical advisor to line of business leadership on strategy, population health, medical cost, quality, and regulatory priorities, develop and execute clinical strategy in alignment with organizational growth, quality, and financial objectives. Identify clinical and market opportunities to improve member...

Job Description: Summary: The Senior Medical Director is a strategic clinical and business leader responsible for advancing the health plan's line of business focus through value-based care, population health, medical management, quality improvement, risk adjustment, product design, and clinical transformation. This role partners closely with line of business leadership, network and provider contracting, actuarial, finance, quality, pharmacy, analytics, care management, and operations to improve clinical outcomes, member experience, provider performance, and total cost of care while ensuring compliance with CMS requirements. Essential Accountabilities: Serve a senior clinical advisor to line of business leadership on strategy, population health, medical cost, quality, and regulatory priorities, develop and execute clinical strategy in alignment with organizational growth, quality, and financial objectives. Identify clinical and market opportunities to improve member...

Job Description: Summary: This position is responsible for and participates in a wide range of provider, patient, and employer initiatives and programs. The pharmacist supports all of our lines of business which include Medicare, Commercial, Exchange (Marketplace) and Medicaid. The focus of the UM Pharmacist is to manage the quality, appropriateness, safety and cost of medications for our members through the medical management of drugs across our pharmacy and medical benefits. Essential Accountabilities: Level I Conducts drug prior authorization, exception and medical necessity reviews. Works with requesting providers or internal staff to determine whether the submitted clinical information and patient presentation meet the criteria for approval according to the drug policy, formulary availability, and specific coverage criteria. Conducts first line appeal and grievance reviews for medical and pharmacy drugs in accordance with compliance standards. Conducts...

Job Description: Summary: This position is responsible for and participates in a wide range of provider, patient, and employer initiatives and programs. The pharmacist supports all of our lines of business which include Medicare, Commercial, Exchange (Marketplace) and Medicaid. The focus of the UM Pharmacist is to manage the quality, appropriateness, safety and cost of medications for our members through the medical management of drugs across our pharmacy and medical benefits. Essential Accountabilities: Level I Conducts drug prior authorization, exception and medical necessity reviews. Works with requesting providers or internal staff to determine whether the submitted clinical information and patient presentation meet the criteria for approval according to the drug policy, formulary availability, and specific coverage criteria. Conducts first line appeal and grievance reviews for medical and pharmacy drugs in accordance with compliance standards. Conducts...

Join us in pioneering breakthroughs in healthcare. For everyone. Everywhere. Sustainably. Our inspiring and caring environment forms a global community that celebrates diversity and individuality. We encourage you to step beyond your comfort zone, offering resources and flexibility to foster your professional and personal growth, all while valuing your unique contributions. The Senior Manager, KOL & External Engagement Strategy is responsible for developing and executing a coordinated approach to key opinion leader (KOL) engagement, voice-of-customer (VOC) insights, advisory panels, speaker programs, webinars, and advocacy initiatives across clinical areas. The role reports into Marketing Excellence and Marketing Communications and serves as a critical connector between external stakeholders and internal teams. This position partners closely with Product Management, Upstream Marketing (New Product Development), Medical Affairs, Clinical Affairs, Government Affairs, and...

Join us in pioneering breakthroughs in healthcare. For everyone. Everywhere. Sustainably. Our inspiring and caring environment forms a global community that celebrates diversity and individuality. We encourage you to step beyond your comfort zone, offering resources and flexibility to foster your professional and personal growth, all while valuing your unique contributions. Siemens Healthineers is a global leader in medical technology, committed to advancing patient outcomes through continuous innovation in laboratory diagnostics. Our Diagnostics portfolio delivers a comprehensive range of in-vitro diagnostic products and services that support healthcare providers across diverse clinical settings, from centralized reference and hospital laboratories to emergency departments, and physician offices. Our solutions serve a broad range of diagnostics disciplines, including immunochemistry, hematology, coagulation, urinalysis, and blood gas analysis. At Siemens Healthineers, our...

The Opportunity: Tetra Tech is adding a Part-time Environmental Scientist - Entry Level to support our growing environmental consulting practice in New York State and throughout the Northeastern United States. This is a part-time, benefited, hourly position based out of our Rochester, New York office. The successful candidate will primarily support energy projects in a field-based role, helping clients navigate natural resource considerations associated with wildlife, wetlands, and other environmental resources. The ideal candidate will have experience conducting natural resource assessments and collecting high-quality biological field data, including threatened and endangered (T&E) species and avian surveys, as well as the ability to work on solid and hazardous waste remediation sites. A background in wetlands and avian biology with field survey experience is highly desirable. Candidates should have experience collecting biological field data using current...