• Provide clinical oversight and medical direction for musculoskeletal and therapy related programs and services • Ensure clinical policies, guidelines, and practices align with evidence based PM&R and MSK standards of care and applicable regulatory requirements • Serve as the senior clinical authority for MSK related questions, escalations, and complex case reviews • Perform and oversee utilization management reviews for MSK services, including physical therapy, occupational therapy, and related interventions • Conduct medical necessity determinations for prior authorization, concurrent, and retrospective reviews • Review and adjudicate clinical appeals and denials, including peer to peer discussions with ordering and rendering providers • Collaborate with operational and compliance teams to ensure utilization management activities meet contractual, regulatory, and accreditation standards • Act as a client facing clinical leader and PM&R specialist for Health Network One’s MSK service lines • Participate in client meetings, presentations, and consultations to explain MSK clinical programs, utilization management decisions, and outcomes • Support client relationships, retention, and growth by providing credible, data driven clinical guidance • Represent Health Network One with external stakeholders, including health plans, provider partners, therapy networks, and regulatory entities, as appropriate • Partner with the CEO and executive leadership team to support strategic planning, clinical program design, and growth initiatives for MSK services • Provide clinical insight to inform organizational decision making, risk management, and performance improvement efforts • Contribute to the development and refinement of clinical workflows, quality initiatives, and performance metrics aligned with organizational goals • Ensure compliance with federal and state regulations, accreditation standards, and client contractual requirements • Support quality management activities related to MSK services, including audits, reporting, and corrective action planning • Promote a culture of clinical excellence, accountability, and evidence based decision making

At Bayer we’re visionaries, driven to solve the world’s toughest challenges and striving for a world where 'Health for all Hunger for none’ is no longer a dream, but a real possibility. We’re doing it with energy, curiosity and sheer dedication, always learning from unique perspectives of those around us, expanding our thinking, growing our capabilities and redefining ‘impossible’. There are so many reasons to join us. If you’re hungry to build a varied and meaningful career in a community of brilliant and diverse minds to make a real difference, there’s only one choice. Director Medical Affairs, Legacy Therapeutics The Director Medical Affairs MD, Legacy Therapeutics will direct and participate in the planning and administration of activities concerned with the clinical evaluation of legacy products for the purpose of advising on post-marketing activities and maintenance of therapies. Provide advice within the field of medical expertise and specialization to cross-functional teams. Actively manage legacy therapy projects YOUR TASKS AND RESPONSIBILITIES The primary responsibilities of this role, Director Medical Affairs MD, Legacy Therapeutics, are to: - Active participation and effective interaction with Global teams to ensure appropriate US direction of the company’s research and marketing efforts relative to the US environment as well as responsible for the design, planning and execution of an overall medical strategy including creating, organizing and leading Advisory Boards. - Provide support and medical expertise to US cross-functional teams within the Business Unit regarding development of materials, monitoring of published literature, addressing and resolving international, regional and local issues related to products under their responsibility and provide input to company documents to ensure scientific accuracy as well communication and publication programs. - Support evaluation of clinical data and literature and provide USMA input in the preparation of key medical documents for external communication (e.g regulatory agencies). This includes ensuring appropriate USMA input in interactions with the FDA and providing appropriate medical leadership for any interactions. - Providing key strategic US input and reviewing and co-approving clinical study protocols. - Participate Advisory Committees. - Interface with both internal and external (KOLs, advisors, consultants) experts and medical organizations in order to develop and maintain productive contacts. - Provide feedback with the respective line manager in the recruitment, development and performance management of appropriate team members (including cross-functional partners) as well as managing performance and development planning of all direct reports including adhesion to all training and compliance policies. WHO YOU ARE Bayer seeks an incumbent who possesses the following: Required Qualifications: - M.D. Degree or equivalent (DO or MBBS). - Clinically relevant or independent research experience or equivalent experience in the pharmaceutical or related industry or of extensive collaboration with the industry (eg, lead PI and consultant, FDA employee or advisor). - Proven ability to identify and resolve complex problems. - A solid understanding of clinical study design, analysis and interpretation as well as the principles of observational studies and health economics. - Ability to collaborate with a variety of teams and personnel as well as a proven ability to interact effectively with key opinion leaders. - Highly developed ethics and integrity, with demonstrated ethical medical decision-making skills. - Ability to work well on teams as well as ability to assume leadership of a team. - Strong negotiation and influencing skills • Proven ability to implement successful clinical strategies and programs. - Effective communicator with strong oral and written communications skills. - Demonstrated success in leading both internal and cross-functional project teams including contractors and consultants as well as performing successfully under stringent timelines and with competing priorities. - Proven ability to achieve timely approval of dossiers and regulatory submissions and to be able to develop highly successful clinical strategies and programs. Preferred Qualifications: - US Board certification and licensure (active) highly preferred. - 8+ years of relevant experience. Employees can expect to be paid a salary of between $180,400 to $292,000. Additional compensation may include a bonus or commission (if relevant). Additional benefits include health care, vision, dental, retirement, PTO, sick leave, etc.. This salary range is merely an estimate and may vary based on an applicant’s location, market data/ranges, an applicant’s skills and prior relevant experience, certain degrees and certifications, and other relevant factors. This posting will be available for application until at least: April 23, 2026. YOUR APPLICATION Bayer offers a wide variety of competitive compensation and benefits programs. If you meet the requirements of this unique opportunity, and want to impact our mission Health for all, Hunger for none, we encourage you to apply now. Be part of something bigger. Be you. Be Bayer. To all recruitment agencies: Bayer does not accept unsolicited third party resumes. Bayer is an Equal Opportunity Employer/Disabled/Veterans Bayer is committed to providing access and reasonable accommodations in its application process for individuals with disabilities and encourages applicants with disabilities to request any needed accommodation(s) using the contact information below. Equal Opportunity Employer Statement: Notice for U.S. Visitors: All information on this site is subject to compliance with local rule and regulations as they may vary from time to time and across different geographies, including, without limitation, U.S. Executive Orders. Bayer is an E-Verify Employer. Location:United States : Residence Based : Residence Based Division:Pharmaceuticals Reference Code:866966 Contact Us Email:hrop_usa@bayer.com

Requisition Number: 2345838 WellMed, part of the Optum family of businesses, is seeking an internal medicine or family medicine physician to join our Utilization Management team. Optum is a clinician-led care organization that is changing the way clinicians work and live. The Medical Director for Utilization Management will support WellMed Medical Management, Inc. by making utilization management determinations, identifying utilization trends suggesting possible over or under utilization of services and proactively suggesting improvements to WellMed Medical Management's utilization management program. At Optum, you'll have the clinical resources, data and support of a global organization behind you so you can help your patients live healthier lives. Here, you'll work alongside talented peers in a collaborative environment that is guided by diversity and inclusion while driving towards the Quadruple Aim. We believe you deserve an exceptional career and will empower you to live your best life at work and at home. Experience the fulfillment of advancing the health of your community with the excitement of contributing new practice ideas and initiatives that could help improve care for millions of patients across the country. Because together, we have the power to make health care better for everyone. Join us and discover how rewarding medicine can be while Caring. Connecting. Growing together. You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. Position Highlights & Primary Responsibilities: - Assists in development and maintaining an efficient UM program to meet the needs of the health plan members and commensurate with company values - Remain current and proficient in CMS criteria hierarchy and organizational determination processes - Participates in case review and medical necessity determination - Maintain proficiency in compliance regulations for both CMS and delegated health plans - Conducts post service reviews issued for medical necessity and benefits determination coding - Assists in development of medical management, care management, and utilization management protocols - Performs all other related duties as assigned Customer Service: - Oversees and ensures physician compliance with UM plan - Performs all duties in a professional and responsible manner - Responds to physicians and staff in a prompt, pleasant and professional manner - Respects physician, patient, and organizational confidentiality - Provides quality assurance and education of current medical technologies, review criteria, accepted practice of medicine guidelines, and UM policies and procedures with counsel when criterion are not met - Personal and Physician Development - Strives to personally expand working knowledge of all aspects of the UM department - An active participant in physician meetings - Orients new physicians to ensure understanding of company policy and resources available for physician support - Assists in the growth and development of subordinates by sharing special knowledge with others and promotes continued education classes - Attends continuing education classes to keep abreast of medical advancements and innovative practice guidelines In 2011, WellMed partnered with Optum to provide care to patients across Texas and Florida. WellMed is a network of doctors, specialists and other medical professionals that specialize in providing care for more than 1 million older adults with over 16,000 doctors' offices. At WellMed our focus is simple. We're innovators in preventative health care, striving to change the face of health care for seniors. WellMed has more than 22,000+ primary care physicians, hospitalists, specialists, and advanced practice clinicians who excel in caring for 900,000+ older adults. Together, we're making health care work better for everyone. 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 (M.D.), Doctor of Osteopathy (D.O.), or M.B.B.S. - Board certification in Family Medicine, Internal Medicine, or emergency medicine - An active, unrestricted medical license (any state) - 5+ years of post-residency clinic practice experience - Proficiency with Microsoft Office applications Preferred Qualifications: - 2+ years of experience in utilization management activities - 2+ years of experience with acute admissions - 2+ years of experience working in a managed care health plan environment - Bilingual (English/Spanish) fluency *All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. 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. The salary for this role will range from $248,500.00 to $373,000.00 annually based on full-time employment. We comply with all minimum wage laws as applicable. 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. OptumCare 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. OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

GENERAL SUMMARY: The primary objective of this program is to prepare medical residents with a comprehensive understanding of pharmacy benefit management. By the end of the program, participants will appreciate the significance of formulary establishment and understand the various utilization management tools used in administering pharmacy benefits. Required Qualifications Medical resident in good standing at an ACGME-accredited post-graduate residency program Preferred Qualifications PGY-2 or higher Education Doctor of Medicine Doctor of Osteopathic Medicine This role is part of an unpaid program and is not eligible for pay or benefits. We anticipate the application window for this opening will close on: 07/01/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.