[Hiring] Medical Director @Elevance Health

Role Description

The Medical Director is responsible for the administration of medical services to ensure members receive appropriate, cost-effective care. This position is within Elevance Health’s National Accounts line of business, which manages the health plans of some of the nation’s largest companies, representing more than six hundred clients and ten million lives.

The Medical Director may develop and implement programs to improve quality, cost, and outcomes; provide clinical consultation and serve as a clinical and strategic advisor to enhance clinical operations; and identify cost-of-care opportunities that increase value for clients and members.

• Works independently with oversight from the immediate manager.
• Responsible utilization management as well as support to the care management nursing staff of the physician’s national client(s).
• Provides guidance for clinical operational aspects for the client(s).
• Conducts peer-to-peer clinical reviews with attending physicians to discuss review determinations.
• Requires two two-week blocks of primary/back up call per year to maintain regulatory turn-around-time during non-business hours when required. This responsibility is shared equitably among the other Operational Medical Directors.
• Serves as a resource and consultant for other areas of the company.
• Represents the company to external entities (clients) and/or serves on internal and/or external committees.
• Interprets medical policies and clinical guidelines.
• Directs and implements clinical activities that impact healthcare quality, cost, and outcomes.
• Identifies and develops opportunities for innovation to increase effectiveness and quality.

Qualifications

• MD/DO and board certification approved by one of the following certifying boards is required: American Board of Medical Specialties (ABMS) or American Osteopathic Association (AOA).
• Must possess an active unrestricted medical license to practice medicine or a health profession.
• Minimum of 10 years of clinical experience; or any combination of education and experience that would provide an equivalent background.

Requirements

• Prior experience working within a health plan or involvement with hospital-based utilization review activities.

Benefits

• Comprehensive benefits package.
• Incentive and recognition programs.
• Equity stock purchase.
• 401k contribution (all benefits are subject to eligibility requirements).