Role Description The Appeals and Grievances Medical Director is responsible for ongoing clinical review and adjudication of appeals and grievances cases for UnitedHealthcare associated companies. Performance accountabilities include: - Perform individual case review for appeals and grievances for various health plan and insurance products, which may include PPO, ASO, HMO, MAPD, and PDP. - The appeals are in response to adverse determinations for medical services related to benefit design and coverage and the application of clinical criteria of medical policies. - Perform Department of Insurance/Department of Managed Healthcare, and CMS regulatory responses. - Communicate with UnitedHealthcare medical directors regarding appeals decision rationales, and benefit interpretations. - Communicate with UnitedHealthcare Regional and Plan medical directors and network management staff regarding access, availability, network, and quality issues. - Actively participate in team meetings focused on communication, feedback, problem solving, process improvement, staff training and evaluation, and the sharing of program results. - Provide clinical and strategic input when participating in organizational committees, projects, and task forces. What makes your clinical career greater with UnitedHealth Group? You can improve the health of others and help heal the health care system. You can work with an incredible team culture; a clinical and business collaboration that is learning and evolving every day. And, when you contribute, you'll open doors for yourself that simply do not exist in any other organization, anywhere. 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. Qualifications - MD or DO with an active, unrestricted license - Board Certified in an ABMS or AOBMS specialty - No Pediatricians - 5+ years of clinical practice experience - 2+ years of Quality Management experience - Intermediate or higher level of proficiency with managed care - Basic computer skills, typing, word processing, presentation, and spreadsheet applications skills - Internet researching skills - Proven excellent presentation skills for both clinical and non-clinical audiences - Familiarity with current medical issues and practices - Proven excellent telephonic communication skills; excellent interpersonal communication skills - Proven excellent project management skills - Proven data analysis and interpretation skills - Proven creative problem-solving skills - Proven solid team player and team building skills Requirements - All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy Benefits - Compensation for this specialty generally ranges from $248,500.00 - $373,000.00. - 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.

Overview The Medical Science Liaison (MSL) is a field-based representative of the Medical Affairs Organization that supports and represents Shionogi Inc and its products with, and to, key opinion leaders (KOLs), clinicians, institutions, and professional organizations. This includes relationship building and management of KOLs providing for meaningful scientific exchange at national, regional and local levels in both academic and clinical practice settings. The incumbent addresses the specific needs of healthcare professionals (HCPs) by responding to unsolicited requests for information about our marketed and developing products. As a clinical and scientific expert on the company and products, the MSL is responsible for building long-term relationships and establishing rapport with HCPs in hospitals, clinics, and academic centers through scientific disease state and product discussions that support current therapeutic concepts and ensure the safe and effective use of products. The incumbent is also a resource to company management regarding therapeutic area dynamics, business development, and KOL feedback. The MSL also works cross-functionally with internal departments and external resources on clinical and scientific matters. At all times, the MSL fully complies with all applicable federal, state, and local laws and regulations as well as Shionogi Inc. Code of Conduct. policies, standards, work instructions, privacy and data guidelines. Responsibilities Responsibilities The following outlines the main duties of the role. This summary is not meant to be an exhaustive, but provides a high-level overview of the key activities of the role. - Establishes, manages, and maintains successful relationships with relevant healthcare entities including, but not limited to, KOLs, HCPs, academic institutions, payors, patient organizations, etc. to serve as the educational, research and clinical/scientific informational resource. - Designs and executes plans for the assigned MSL region with alignment to medical strategy and KOL priorities. - Identify relevant HCPs in context of medical strategy and patient needs. - Responds to and documents unsolicited medical and scientific requests for information; Liaises with investigators on unsolicited requests for investigator-initiated research submissions studies. - Delivers, and may develop/design, fair-balanced clinical and scientific presentations for HCPs, payors, and patient organizations in response to unsolicited requests for information on company products with with medical review committee approval. - Identifies and trains speakers for advisory boards, symposia, and educational programs with presentation materials, including approved slide sets, abstracts, posters, etc. - Attends national and regional medical/scientific meetings and symposia as a representative of the company and engages in discussions with attendees as appropriate; attends scientific sessions and poster presentations, gathers information, and summarizes findings; as appropriate, cultivates professional relationships from interactions at these meeting. - Evaluates competitor research and information relevant to company therapeutic areas, objectives, activities, and product priorities; stays current on therapeutic advances; analyzes and applies relevant intelligence findings and presents data/insight to appropriate internal stakeholders. - Collaborates and works effectively across multi-disciplinary internal groups (Clinical, Regulatory, Commercial (Sales and Marketing), Legal, Compliance, etc.) to support Shionogi medical/scientific and business objectives. This includes providing disease state, clinical and scientific training as requested across functional teams and providing input to management on therapeutic and research advances, business development opportunities/risks, and KOL feedback. - Maintains a thorough awareness of medical/clinical, regulatory, compliance, and quality issues and processes as they apply to the Company’s therapeutic areas and adheres to, and supports the standards established by the company. - Completes accurate and timely submission of administrative reports, projects, expense reports, training, KOL documentation, conference reports, and all other required documentation. - Analyzes operational data to identify trends, root causes, and opportunities for improvement. Develops and tracks key performance indicators (KPIs) and associated metrics as assignment by Medical Affairs leadership. - Designs and ensures delivery of training programs at high standards to build operational excellence capabilities within the team. - Works closely with cross-functional teams, including medical affairs, clinical operations, regulatory affairs, commercial and marketing, and quality assurance, to drive alignment and achieve operational goals. - Leads change management efforts to ensure successful implementation of process improvements and operational initiatives. - Regularly assesses industry best practices, internal needs, opportunities and challenges, and identify fit-for-purpose opportunities to adopt and enhance medical impact and create operational efficiencies. - Other duties as assigned. Minimum Job Requirements Qualifications - Doctoral level degree in life sciences program with strong scientific knowledge highly preferred. Post grad in virology, infectious disease, epidemiology or related fields considered. - Previous MSL experience in the pharmaceutical/biopharmaceutical industry required with previous respiratory infectious disease experience preferred; experience in COVID-19 preferred OR, previous MSL experience in the pharmaceutical/biopharmaceutical industry preferred with previous respiratory infectious disease experience required. - Experience in the outpatient medical community as well both pre- and post-launch product approval activities is preferred. - Demonstrates clinical, scientific, and technical knowledge within infectious diseases or respiratory diseases preferred but not required. - Understanding of the pharmaceutical industry and business strategies. - Knowledgeable with current regulatory guidelines to ensure corporate compliance in all activities, including those related to scientific interactions, unsolicited questions, clinical trials, and research. - Behaves in an ethical and professional manner, adhering to the company's guidelines and regulatory requirements. Competencies - Adept at building and maintaining relationships with key healthcare providers and other industry stakeholders. - Works collaboratively with internal colleagues within and across groups, as well as, external organizations across all levels and roles. - Communicates effectively and presents scientific and medical information to a wide range of audiences, including healthcare providers, researchers, industry, cross-functional colleagues, payors, and key opinion leaders. - Ability to manage multiple projects and initiatives simultaneously, and be able to organize, communicate, and prioritize work effectively. - Thinks strategically, identifies opportunities and finds innovative solutions to challenges to advance the interests of the company. - Demonstrated computer skills in MS Word, Excel, Outlook, PowerPoint, MS TEAMS, and video conferencing. - Demonstrated ability to be flexible and adapt to the changing healthcare environment, pharmaceutical industry conditions, healthcare professionals’ and organizational needs. Other Requirements - Ability and willingness to travel up to 75% of time by automobile, train, or air to accomplish MSL responsibilities. Typically, MSL travel consists of approximately 3 days a week in the designated MSL region and attending conferences and/or other meetings 6-10+ annually. - Must live within the boundaries of the assigned geographic territory and within a commutable distance to a large airport. - Driving in a safe manner to required meetings and appointments. - Valid driver’s license with a clean driving record and ability to pass a complete background check. - Must have valid licenses and credentialing required to conduct business in assigned territory. Additional Information The base salary range for this full-time position is $175,000 - $210,000. Individual pay is determined by several factors, which include but are not limited to: job-related skills, experience, and relevant education or training. The range does not include the comprehensive benefits, bonus, long-term incentive, applicable allowances, or any additional compensation that may be associated with this role. Disclaimer The job description is not designed to cover or contain a comprehensive listing of requirements, duties or responsibilities that are required of the employee. Other requirements, duties and responsibilities may change or be assigned at any time with or without notice. You acknowledge and agree that information described herein may be disclosed to applicable regulatory authorities, alliance partners and/or third party service providers as necessary for Shionogi to fulfil its obligations under applicable laws, including but not limited to compliance with regulatory inspections and/or audits. EEO Shionogi Inc. is an equal opportunity employer supporting individuals with disabilities and veterans. All qualified applicants will receive equal consideration for employment opportunities based on valid job requirements without regard to race, color, religion, sex (including pregnancy), marital status, national origin, age, ancestry, citizenship, disability, genetic information, status as a disabled veteran, a recently separated veteran, Active Duty Wartime or Campaign Badge Veterans, and Armed Forces Service Medal Veterans, or any other characteristic protected by applicable law. It is the policy of Shionogi Inc. to undertake affirmative action for protected veterans and individuals with disabilities in compliance with all federal, state, and local requirements to recruit a diverse pool of protected veteran and individuals with disabilities applicants and to ensure that our employment practices are, in fact, non-discriminatory. If you are qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation if you are unable or limited in your ability to use or access this website to apply for a vacancy as a result of your disability. You can request accommodations by calling 973-307-3550 or by sending an email to ShionogiHR@shionogi.com.

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. The Behavioral Medical Director position is responsible for providing oversight to and direction of the Utilization Management Program and performing peer reviews as necessary. This individual will interact directly with Psychiatrists, Behavioral Health Providers, and other clinical professionals who consult on various processes and programs. The Behavioral Medical Director is part of a leadership team that manages development and implementation of evidence-based treatments and medical expense initiatives and will also advise leadership on health care system improvement opportunities. They are responsible for maintaining the clinical integrity of the program, including timely peer reviews, appeals and consultations with providers and other community-based clinicians, including general practitioners, and will work collaboratively with the Health Plan Medical Director, Clinical, Network and Quality staff. At Optum, our clinical vision drives the team to improve the quality of care our consumers receive. You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities: - Ensuring delivery of cost-effective quality care that incorporates recovery, resiliency and person-centered services - Responsible for Level of Care guidelines and utilization management protocols - Oversight and management, along with the Clinical Director and Clinical Program Director, utilization review, management and care coordination activities - Provide clinical oversight to the clinical staff, oversee the management of services at all levels of care in the benefit plan - Keep current regarding Evidence Based Practices and treatment philosophies including those that address Recovery and Resilience 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: - Doctor of Medicine or Osteopathy - Current license to practice as a physician in the state of Minnesota (residence not required) - Board certified in Psychiatry - Knowledge of post-acute care planning such as home care, discharge planning, case management, and disease management - Demonstrated understanding of the clinical application of the principles of engagement, empowerment, rehabilitation and recovery - Computer and typing proficiency, data analysis and solid organizational skills Preferred Qualifications: - 3+ years of experience as a practicing psychiatrist post residency - Managed care experience - Experience in public sector delivery systems and experience in state specific public sector services - Experience working with community-based programs and resources designed to aid the State Medicaid population *All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy Compensation for this specialty generally ranges from $268,000 - $414,000. 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.

Medical Records Clerk Location: Pensacola, Florida, United States Department: Billing Job Description: Medical Records Clerk Job Description Mako Medical is currently searching for an experienced and friendly medical records clerk to join our administrative team. This is a full-time hybrid role; you will complete training in-office and will transfer to remote work once training is completed. After the training period you will be required to work in the office 1-2 days a week. You will be responsible for a variety of tasks including issuing medical records to payers according to laws and regulations, complete clerical duties including answering phones, responding to emails, and assisting Customer Service Department staff with incoming calls on a as needed basis. The successful candidate will have in-depth knowledge of medical terminology, processes, and administrative duties. To excel in this position, you should also demonstrate excellent communication and organizational skills. Ultimately, you will work with a small team to assist with the responsibilities described and fill in with other Medical Billing assignments as needed. Gathering patient demographic and personal information Issuing medical files to persons and agencies according to laws and regulations Helping with departmental audits and investigations Ensuring medical records requests are completed in an accurate and timely manner Completing clerical duties, including answering phones, responding to emails Additional assignments as assigned by supervisor · Associates Degree preferred · A minimum of 2 years’ experience in a similar role · Advanced understanding of medical terminology and administration processes · Proficient in information management programs and MS Office · Outstanding communication and interpersonal abilities · Strong attention to detail with excellent organizational skills