• Become a trusted advisor to sophisticated clients and families navigating life-altering oncology diagnoses, helping them make informed decisions during some of the most important moments of their lives. • Unlock access to innovative diagnostics, precision medicine approaches, clinical trials, and emerging therapies that may not otherwise be identified or pursued. • Build meaningful relationships with leading cancer centers, physician-scientists, researchers, and industry innovators to expand possibilities for client care. • Help shape the future of PHM's Premier Client Services program by bringing clinical expertise, scientific curiosity, and operational insight to a rapidly growing service line. • Contribute to a care model that redefines what highly personalized oncology support can look like for individuals seeking the very best care available.

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 - 5+ years of clinical practice experience - 2+ years of Quality Management experience - Familiarity with current medical issues and practices - Intermediate or higher level of proficiency with managed care - Proven excellent telephonic communication skills; excellent interpersonal communication skills - Proven excellent project management skills - Proven data analysis and interpretation skills - Proven excellent presentation skills for both clinical and non-clinical audiences - Proven creative problem-solving skills - Proven basic computer skills, typing, word processing, presentation, and spreadsheet applications skills. Internet researching 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 - Comprehensive benefits package - Incentive and recognition programs - Equity stock purchase - 401k contribution (all benefits are subject to eligibility requirements) Company Description 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.

Role Description The Medical Director provides physician support to Enterprise Clinical Services operations, the organization responsible for the initial clinical review of service requests for Enterprise Clinical Services. The Medical Director collaborates with Enterprise Clinical Services leadership and staff to establish, implement, support, and maintain clinical and operational processes related to benefit coverage determinations, quality improvement, and cost-effectiveness of service for members. The Medical Director's activities primarily focus on the application of clinical knowledge in various utilization management activities with a focus on pre-service benefit and coverage determination or medical necessity (according to the benefit package), and on communication regarding this process with both network and non-network physicians, as well as other Enterprise Clinical Services. The Medical Director collaborates with a multidisciplinary team and is actively involved in the management of medical benefits. The collaboration often involves the member’s primary care provider or specialist physician. It is the primary responsibility of the Medical Director to ensure that the appropriate and most cost-effective quality medical care is provided to members. You’ll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities: - Conduct coverage reviews based on individual member plan benefits and national and proprietary coverage review policies, render coverage determinations. - Document clinical review findings, actions, and outcomes in accordance with policies, and regulatory and accreditation requirements. - Engage with requesting providers as needed in peer-to-peer discussions. - Be knowledgeable in interpreting existing benefit language and policies in the process of clinical coverage reviews. - Participate in daily clinical rounds as requested. - Communicate and collaborate with network and non-network providers in pursuit of accurate and timely benefit determinations for plan participants while educating providers on benefit plans and medical policy. - Communicate and collaborate with other internal partners. - Call coverage rotation. Qualifications - M.D or D.O. - Board certification in General Surgery through the American Board of Medical Specialties (ABMS) or the American Osteopathic Association (AOA) with strong focus in Vascular Surgery. - Active unrestricted license to practice medicine. - 5+ years of clinical practice experience after completing residency training. - Sound understanding of Evidence Based Medicine (EBM). - Experience performing vascular surgeries and procedures. - Solid PC skills, specifically using MS Word, Outlook, and Excel. - Proven ability to participate in call coverage rotation. Preferred Qualifications - Experience in utilization and clinical coverage review. - Proven excellent oral, written, and interpersonal communication skills, facilitation skills. - Proven data analysis and interpretation aptitude. - Proven innovative problem-solving skills. - Proven excellent skills for both clinical and non-clinical audiences. Benefits - Comprehensive benefits package. - Incentive and recognition programs. - Equity stock purchase. - 401k contribution (all benefits are subject to eligibility requirements). 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.

Title: Director, Medical Journals Location: Rosemont United States Job Description: The American Academy of Dermatology is seeking a Director, Medical Journals located in our Rosemont office responsible for spearheading the strategic management of the Academy's flagship scholarly, peer-reviewed journals under the umbrella brand of the Journal of the American Academy of Dermatology. This position will set the tone for the journals' business, collaborate with editors, publisher, and Academy to help establish the journals' strategic objectives, and strategize to reach all goals. Additionally, the role will establish and uphold the journal and Academy policies. This role will keep current with the changing needs of peer-reviewed publishing. About Us: The American Academy of Dermatology (Academy), founded in 1938, is the largest, most influential, and most representative of all dermatologic associations. A sister organization to the Academy, the American Academy of Dermatology Association is the resource for government affairs, health policy and practice information for dermatologists, and plays a major role in formulating policies that can enhance the quality of dermatologic care. With a membership of more than 21,000 members worldwide, the Academy is committed to: advancing the diagnosis and medical, surgical, and cosmetic treatment of the skin, hair, and nails; advocating high standards in clinical practice, education, and research in dermatology; and supporting and enhancing patient care for a lifetime of healthier skin. The Journal of the American Academy of Dermatology (JAAD) portfolio of peer reviewed scholarly journals is a highly revered and valuable brand of the AAD dedicated to helping dermatologists improve patient outcomes. The portfolio consists of the flagship JAAD hybrid journal currently ranked #1 in the field of dermatology with a 2024 journal impact factor (JIF) of 11.8, as well as three gold open access journals - JAAD Reviews, JAAD Case Reports, and JAAD International (2024 JIF of 5.2), all robust in citations and submissions. We are staffed by a highly professional and experienced editorial team awaiting your strategic direction; and we have several exciting projects underway with far-reaching impact on the journals, on which this Director will have influence. To learn more about the Academy please visit our website at www.aad.org, jaad.org, and follow us on these social media outlets: - Facebook ((https://www.facebook.com/JAADjournals/) - Instagram(https://www.instagram.com/jaadjournals/) - LinkedIn (https://www.linkedin.com/company/jaad-journals/posts/) - X (https://x.com/JAADjournals) Responsibilities: - Direct editorial operations and provide publisher oversight for the JAAD medical journals portfolio to ensure all objectives are met, including content quality and innovation, editorial and design excellence, production speed, timeliness, and profitability. - Work with the Editors, Editorial Office Staff, Publisher, Academy Staff and Leadership to leverage the value of the JAAD brand throughout the Academy and the specialty of dermatology. Serve as Staff Liaison to the JAAD Publications Committee; support work of this group as a communications conduit between AAD and JAAD editors. - Recruit, develop, motivate, and manage editors, staff and outsourced services for the JAAD journals, ensuring that all duties are properly executed to achieve the goals and objectives assigned. Conduct performance appraisals, develop annual goals and objectives, as well as individual development plans for the journals' editorial office staff. - Work with the Communications, Marketing, and Member Relations and Engagement departments to facilitate and support efforts to increase the value of the JAAD brand to members. Review, provide feedback on, and suggest new opportunities for various programs related to the journals and journal-based education. Provide input on journal social engagement strategies (Facebook, X, Instagram, LinkedIn). Develop, report on, and oversee journal Inclusion initiatives. - Direct the administrative management of the journal, including developing and presenting all related budgets, expense approvals, and establishment of policies and procedures, assuring that contractual terms are met. - Conduct periodic searches/Request For Proposals for editors and publisher. Negotiate multi-year contracts for the journal portfolio. - Recommend staffing, as well as the hardware and software needed to support the journals' editorial office operations. Interface with Publisher on software needed to produce the journals and execute on digital publishing initiatives. - Identify new growth areas for editorial initiatives and new or expanded publishing business opportunities for society consideration. Develop cohesive business plans, strategies, and metrics to track, evaluate, and report journal success as required. Requirements: - Bachelor's degree or equivalent experience in Communications, Journalism, or equivalent required. Master's degree is desired. - Minimum 12 years' experience with progressive management responsibility required. - Minimum of 8 years of people management including leading, mentoring, and coaching direct and indirect reports. - Extensive background in all aspects of managing and producing peer-reviewed publications, digital and print collateral required. - Background in editing and proofreading, graphic design, print production, advertising, as well as direct and social marketing is preferred. - Experienced skills in peer-reviewed journal management, project management, budgeting, and contract negotiation required. - Excellent verbal and written interpersonal communication skills necessary. - Ability to juggle multiple projects and meet deadlines required. - Advanced skills in MS Office and PC applications for publications management required. - Knowledge of digital publishing, including video and audio production, and social media preferred. We offer a competitive compensation plan and benefits package including medical/dental/vision/life insurance as well as a matching retirement contribution, tuition reimbursement, bonus program, pension plan, paid vacation/medical/personal days, work-life balance, recognition program and casual work environment. More information about our compensation and benefits can be reviewed on the detailed job ad on our website. The Academy offers a hybrid work environment; providing time in the office for in-person collaboration and the opportunity to work remotely for focus time. We are building a workplace where our employees are excited to come to work every day because of the culture that we are creating together - one of respect, transparency, and collaboration. A workplace in which we demonstrate care and commitment, celebration, community, and focused learning that contributes to the mission of advancing excellence in dermatologic care. Salary Range:$195,000.00 To $205,000.00 Annually