Overview Actively engages in clinical and technological decisions that directly impact patient lives, while competently servicing our clients. Serves as multiple facilities, masters multiple pharmacy information systems, and serves as trusted advisors to the clinicians whom they serve. Uses specialized software and communications platforms that create a vibrant community of connected professionals.   This is a Full Time, 40hr per week, benefitted position. Day shift    Dartmouth is the best where it matters most!   DH Offers You: Employees hired to work at least 0.50 FTE (20 hours per week) and their eligible dependents may participate in Dartmouth Health benefit plans on the employee’s first day of employment. Medical Insurance: Two medical plans available through Anthem BC/BS: Employees also receive a base employer contribution of 4% of biweekly pay plus a High Deductible Health Plan (HDHP) that is matched with a Health Savings Account and a PPO Plan that features higher premiums balanced by copays and lower deductibles. Retirement: Employee contributions are vested immediately. Biweekly matching contribution of 50% on up to 4% of pay saved—for a maximum match of 2% of pay. Paid Time Off: Paid time off is accrued per pay period based on hours worked. This includes six paid holidays. Shift Differential:10% evening, 20% night, and 15% weekend shift differentials when applicable. Tuition Reimbursement: Up to $3,000 per year. Dental Vision   Responsibilities - Utilizes remote order entry and order verification. - Therapeutic drug monitoring and management. - Medication verification and drug utilization review. - Pharmacy consults and recommendations- collaborating with specialty pharmacists as needed. - Serves as a consultation resource to medical and nursing staff. - Exercises sound professional judgment in assuming responsibility for the medication use process and for patient outcomes, following pre-established policies, procedures, and protocols. - Approves medication for dispensing to patients at contracted hospitals per physician request. Interpret and evaluate medication orders and transcribe to computerized patient medication profiles. Maintains accurate and complete medication profiles. - Ensures safe, appropriate, cost effective medication therapies for patients. - Monitors medication therapy by assessment of: - Therapeutic appropriateness of the regimen (e.g. indication for use, drug selection, dosage). - Therapeutic duplication of the regimen. - Appropriateness of the route and method of administration. - Patient compliance with the regimen. - Medication/medication, medication/food, medication/laboratory test, and medication/disease interactions. - Clinical and laboratory data to evaluate the efficacy of therapy and to anticipate toxicity and adverse effects. - Physical signs and clinical symptoms relevant to therapy. - Reads, extracts, and interprets information in patient charts accurately. - Detects and reports suspected adverse drug reactions accurately and in a timely manner. - Sustains the formulary by minimizing non-formulary procurements, utilizing therapeutic substitution protocols, P&T committee approved drug use criteria; and promoting rational drug therapy selection. - Provides clinical consultation and clarification to practitioners. Suggests appropriate, cost, effective therapeutic alternatives to medical staff, as needed. - Provides accurate, adequate, and timely drug information to the professional staff. - Assists in discharge planning when requested. Counsels patient/families concerning proper drug administration, potential drug side effects and precautions, and discharge medication orders. Helps locate medication supplies not generally available. - Documents all clinical activities and interventions accurately and completely. - Participates in the quality improvement and medication use review activities of the department. - Participates in the development and presentation of orientation, education, and training programs for the pharmacy, medical, nursing and other staff members. - As relevant, oversees and directs Pharmacy support personnel. Verifies the daily activities of Pharmacy Technicians. Provides input into support personnel performance reviews, as applicable. - Maintains competence required to perform assigned job functions. - Reviews current literature and other materials pertinent to the practice of pharmacy. - Attends staff meetings, educational, and training programs as appropriate. - Participates in assigned committees (e.g. Pharmacy and Therapeutics). - Responds to poison calls, as required. Provides clinical information regarding the treatment of overdoses and accidental ingestion. - Performs other duties as required or assigned. Qualifications - Graduate of an ACPE-accredited School of Pharmacy with a Bachelor's of Science in Pharmacy; Pharm D degree preferred. - 5 Years or more professional pharmacy experience required. - Must have at least 3 years of clinical hospital inpatient pharmacy experience, health system experience preferred. - Must be able to work independently with minimal direct supervision, to set priorities, make critical decisions, respond quickly to emergency requests, handle frequent interruptions, and adapt to changes in workload. - Maintains customer-service focus to achieve excellent working relationship with the remote contracted facilities. - Good written and verbal communication skills are essential. - Must be currently licensed to practice in the state of NH, and be willing to seek license reciprocity in multiple states. - If working from home, must have high-speed internet access and a HIPAA compliant dedicated workspace. Required Licensure/Certifications - Must be currently licensed to practice in the state of NH.

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description The Utilization Review Medical Director is responsible for conducting clinical reviews of Durable Medical Equipment (DME) and related requests to support Integra’s Utilization Management (UM) operations. This full-time, salaried role functions within a structured, high-volume authorization review queue and requires adherence to workflow timelines, clinical accuracy standards, and productivity expectations. The Medical Director ensures determinations are made in accordance with Medicare and Medicaid guidelines, health plan–specific criteria, internal policies, and regulatory requirements. This role is best suited for physicians who thrive in a process-driven environment and are committed to consistency, compliance, and evidence-based decision making. - Conduct timely clinical reviews of DMEPOS authorization requests using applicable criteria, including LCDs, Medicaid Manuals, InterQual, MCG, internal medical policies, and health plan requirements. - Function within a real-time review queue and maintain continuous case throughput in alignment with organizational turnaround and productivity standards. - Evaluate clinical documentation, identify missing elements, and render determinations supported by clear clinical rationale. - Review cases escalated by UM staff and/or UM Leadership when criteria do not apply to the enrollee’s unique clinical situation or when clinical judgment is required. - When appropriate, consult with external board-certified reviewers, engage with ordering practitioners, or conduct additional clinical dialogue prior to rendering a determination. - Participate in Peer-to-Peer (P2P) discussions, including maintaining availability for scheduled appointment times. - Document all clinical decisions clearly, concisely, and consistently in accordance with internal SOPs, NCQA standards, and regulatory expectations. - Maintain inter-rater reliability and participate in periodic calibration reviews to support consistency across the UM program. - Serve as a clinical resource for UM team, providing guidance on clinical interpretation, criteria application, and complex case review. - Support internal and external audit activities as needed, including NCQA accreditation, health plan audits, and state Medicaid reviews. - Notify leadership of observed trends, potential quality concerns, or opportunities to strengthen criteria alignment or operational workflows. - Maintain up-to-date knowledge of Medicare, Medicaid, DMEPOS policies, clinical standards of care, and regulatory updates relevant to UM. Qualifications - MD or DO degree - Board certification in Internal Medicine, Family Medicine, or Physical Medicine & Rehabilitation - Eligible for participation in Medicare, Medicaid, and other federally funded programs; no current or past OIG or state sanctions - Experience performing utilization management or clinical review activities - Strong written and verbal communication skills with emphasis on documentation accuracy - Ability to work effectively in a high-volume, queue-based workflow with daily review expectations - Familiarity with electronic UM systems and authorization platforms - Experience with DMEPOS reviews - Experience with NCQA UM accreditation standards - Prior UM experience for MLTC, Medicaid, or Medicare Advantage plans Requirements - Full-time remote role requiring consistent availability during standard business hours and responsiveness to daily assignments. - Case volume and mix vary; continuous throughput and timely review completion are required. - Must maintain a quiet, secure, and compliant environment for reviewing PHI and participating in P2P calls. - Secondary employment or consulting arrangements are permitted only if they do not interfere with the full-time expectations and require disclosure/approval. - Daily accountability measures, productivity monitoring, and adherence to all UM workflows are required. Benefits - Competitive compensation and annual bonus program - 401(k) retirement program with company match - Company-paid life insurance - Company-paid short term disability coverage (location restrictions may apply) - Medical, Vision, and Dental benefits - Paid Time Off (PTO) - Paid Parental Leave - Sick Time - Paid company holidays and floating holidays - Quarterly company-sponsored events - Health and wellness programs - Career development opportunities - Remote Opportunities

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description The Women’s Health Field Medical Team Lead is an integral member of the Field Medical Affairs Leadership Team. The Team Lead provides leadership and management of the Women’s Health Medical Science Liaison (MSL) and Clinical Liaison (CL) teams in support of and alignment with Medical Affairs and Organon corporate objectives. - Build, on-board, lead, manage, develop, and coach the Women’s Health MSL/CL team. - Define territories and geographic locations of FMDs based on KOL mapping data and business needs, and track qualitative and quantitative metrics to meet objectives. - Create, anticipate, update, and implement training plans and field-based training curriculum to ensure MSLs/CLs possess the highest levels of product and disease expertise and scientific acumen. - Actively manage MS/CL performance assessments, provide and document on-going coaching, assist with creation and execution of development plans, and monitor performance against expectations. - Proactively and compliantly collaborate with Commercial and other internal stakeholders and direct MSLs appropriately within legal and compliance policies to implement medical strategies that support launch operating plan and corporate objectives to establish Organon as a leader in Women’s Health. - Collaborate on the development and implementation of the scientific communication plan, medical-to-medical materials, and conduct of research including facilitation of investigator-initiated trials as well as investigator selection, relationship management, and site performance for Organon sponsored research. - Maintain scientific and technical expertise in Women’s Health. Qualifications - PharmD, PhD, MD or equivalent education with demonstrated ability to effectively lead and coach scientific/medical colleagues. - Five plus years pharmaceutical industry experience in a field-based medical role with proven competency in HCP engagement and education. - Three plus years direct management experience of Field Medical teams. - Women’s Health experience is preferred. - Ability to develop and maintain strong, collaborative, and long-term relationships with colleagues, healthcare providers, decision makers, and organizations. - Demonstrable effective leadership skills (by example and through accomplishments), and the ability to step forward to handle challenges within scope of authority. - Excellent interpersonal skills in both one-on-one and group settings and dedicated team player. - Strong oral communication, written communication, presentation, and coaching skills. - Highly motivated self-starter with an entrepreneurial spirit and commitment to personal and career development. - Desire to work in a quickly changing and fast-paced growing business. - Unrelenting dedication to delivering results and a desire to shape the strategic goals of the business. Willing to roll up your sleeves to get the job done. - Ability to overcome ambiguity and challenge the status quo. - Manage multiple programs with competing and aggressive timelines - prioritize activities and work independently. - Excellent written and oral communication skills. Experienced presenter of key messages to broad audiences including Senior Stakeholders. Requirements - #LI-Remote Benefits - Under various U.S. state laws, Organon is required to provide a reasonable estimate of the salary range for this job. Final salary determinations take a number of factors into account including, but not limited to, primary work location, relevant skills, education level, and/or prior work experience. - The applicable salary range for this position in the U.S. is stated below: $185,200.00 - $315,100.00. - Benefits offered in the U.S. include a retirement savings plan, paid vacation and holiday time, paid caregiver/parental and medical leave, and health benefits including medical, prescription drug, dental, and vision coverage in accordance with the terms and conditions of the applicable plans.

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description The Health Plan Data and Medical Policy Clinician analyzes data, as well as coverage, payment, and coding policies, reviews findings, and informs, supports, and makes recommendations to Utilization Management leadership as well as other Clinical Programs at Martin’s Point Healthcare. The Senior Clinical Analyst uses their extensive clinical and coding knowledge and analytical expertise to guide and educate leaders on health plan data clinical optimization from a range of operational lenses and levels of analysis as well as informing system configuration, data feed requirements, and reporting specifications. This individual develops medical policies for the purpose of Utilization Management and Medical Necessity determinations. This individual will also assist in development and maintenance of Prior Auth List. Qualifications - Associates degree in nursing - BSN preferred - Current, unrestricted Registered Nurse licensure in Maine - One or more of the following Certified Professional Coder Certifications (CPC, CCS, CCA, CPMA) - 5+ years medical management experience in a managed care setting including Quality Management, Case Management, Disease Management, Utilization Management and Population Health - Experience related to reporting and analysis of health care data ideally in the areas of managed care, health care delivery, code sets, and/or reimbursement - Experience with ICD10, CPT, HCPCS, and Revenue coding and payment systems for managed care - Experience with creating medical policies under the Medical Policy Committee - Experience with Prior Auth list review, addition and deletion of codes driven by evidence and utilization data - Experience in creating, reconciling, summarizing, and analyzing data with SQL knowledge preferred Requirements - Knowledge of health plan system application configuration/functionality and reporting - Maintains working knowledge of DOD, CMS, NCQA, CCMC, State/Federal regulations, and contractual obligations that affect HMD activities and departmental processes through collaboration with all related health plan departments - Maintains exemplary knowledge of each health plan line of business and impact(s) to HMD functions - Maintains exemplary knowledge of coding principles - Maintains knowledge of payment systems (IPPS, OPPS, PFS, DRG, APC, DMEPOS, …) and impact on reimbursement - Maintains an understanding of health plan quality standards and measurements - Maintains knowledge of managed care computer systems, features, reporting, claims system, and claims processing practices including systems used throughout Martin’s Point (e.g., QNXT, Athena, Salesforce, Microsoft Office, iPro, SharePoint, Optum products, Cognos, Tableau, SQL Server Management, etc.) Skills - Excellent interpersonal, verbal, and written communication skills including team building, and quality improvement skills Abilities - Demonstrates an understanding of and alignment with Martin’s Point Values - Demonstrated ability to manage, organize and prioritize workload and multiple competing demands in a timely accurate manner and function independently - Demonstrated knowledge of project management principles including ability to identify root causes and implement creative solutions with strong analytical and problem-solving skills - Ability to manage complex interdepartmental processes utilizing data to inform decision making and evaluate impacts. Aptitude for matching business requirements to potential software solutions