[Hiring] Medical Director-Psychiatrist (Child Adolescence) @Elevance Health

Role Description

The Medical Director-Psychiatrist (Child Adolescence) will have program management responsibilities including:

• Clinical policy development
• Program development/implementation
• Overseeing clinical/non-clinical activities
• Utilization review/management

May also:

• Develop and implement programs to improve quality, cost, and outcomes
• Provide clinical consultation and serve as clinical/strategic advisor
• Identify cost of care opportunities
• Serve as a resource to staff including Medical Director Associates
• Be responsible for an entire clinical program

How you will make an impact:

• Support clinicians to ensure timely and consistent responses to members and providers
• Provide guidance for clinical operational aspects of a program
• Conduct peer-to-peer clinical reviews with attending physicians or other providers
• May conduct peer-to-peer clinical appeal case reviews
• Serve as a resource and consultant to other areas of the company
• Represent the company to external entities and/or serve on committees
• Interpret medical policies and clinical guidelines
• Develop and propose new medical policies based on changes in healthcare
• Lead, develop, direct, and implement clinical and non-clinical activities
• Identify and develop opportunities for innovation to increase effectiveness and quality

Qualifications

• MD or DO and Board certification approved by ABMS or AOA
• Active unrestricted medical license to practice medicine or a health profession
• Minimum of 10 years of clinical experience
• For Health Solutions and Carelon organizations, minimum of 5 years of experience providing health care
• Strong oral, written, and interpersonal communication skills
• Problem-solving, facilitation, and analytical skills

Requirements

• Must be located in a state or territory of the United States when conducting utilization review or appeals consideration
• Must follow specific policies and procedures if assigned to any Government Business Division entity
• Experience working in a managed care environment strongly preferred
• 2-3 years utilization management review experience strongly preferred
• Clinical experience working with child adolescent or ABA cases strongly preferred
• Knowledgeable of Medicaid/Medicare policies and guidelines aligned to the state of Florida strongly preferred

Benefits

• Merit increases
• Paid holidays
• Paid Time Off
• Incentive bonus programs
• Medical, dental, vision benefits
• Short and long term disability benefits
• 401(k) + match
• Stock purchase plan
• Life insurance
• Wellness programs
• Financial education resources