Manager, Medical Director - Behavioral Health (Medicaid and Commercial)
About The Position
Manager, Medical Director- Behavioral Health (Medicaid and Commercial) Location: This role requires associates to be in-office 3 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. Alternate locations may be considered if candidates reside within a commuting distance from an office. Ideal candidates will live in California. The Manager, Medical Director is responsible for the administration of medical services for external accounts – Medicaid and Commercial- including the overall medical policies of the business unit to ensure the appropriate and most cost-effective medical care is received and for the day-to-day management of medical management staff. How you make an impact: Interprets existing policies and develops new policies based on changes in the healthcare or medical arena. Leads, develops, directs and implements clinical and non-clinical activities that impact health care quality cost and outcomes. Identifies and develops opportunities for innovation to increase effectiveness and quality. Serves as a resource and consultant to other areas of the company, may chair or serve on company committees, may be required to represent the company to external entities and/or serve on external committees, conduct peer clinical and/or appeal case reviews and peer to peer clinical reviews with attending physicians or other ordering providers to discuss review determinations, provides guidance for clinical operational aspects of the program. Supports the medical management staff ensuring timely and consistent responses to members and providers. Hires, trains, coaches, counsels, and evaluates performance of direct reports and directly supervises the management of any assigned staff.
Requirements
- Requires MD/DO and Board certification approved by one of the following certifying boards is required, where applicable to duties being performed, 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 in California.
- Unless expressly allowed by state or federal law, or regulation, must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US military base, vessel or any embassy located in or outside of the US.
- Minimum of 10 years of clinical experience: or any combination of education and experience, which would provide an equivalent background.
Nice To Haves
- Management experience preferred.
- Managed care experience preferred.
- Ability to obtain a California license.
- Addiction or Child and Adolescent experience/certification is preferred.
Responsibilities
- Interprets existing policies and develops new policies based on changes in the healthcare or medical arena.
- Leads, develops, directs and implements clinical and non-clinical activities that impact health care quality cost and outcomes.
- Identifies and develops opportunities for innovation to increase effectiveness and quality.
- Serves as a resource and consultant to other areas of the company, may chair or serve on company committees, may be required to represent the company to external entities and/or serve on external committees, conduct peer clinical and/or appeal case reviews and peer to peer clinical reviews with attending physicians or other ordering providers to discuss review determinations, provides guidance for clinical operational aspects of the program.
- Supports the medical management staff ensuring timely and consistent responses to members and providers.
- Hires, trains, coaches, counsels, and evaluates performance of direct reports and directly supervises the management of any assigned staff.
Benefits
- Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements).
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Full-time
Career Level
Manager
Education Level
Ph.D. or professional degree
