Medical Director Associate- Psychiatrist- Pennsylvania Medicaid

Elevance Health • Seven Fields, PA

1d • $235,488 - $353,232 • Hybrid

About The Position

Medical Director Associate- Psychiatrist- Pennsylvania Medicaid Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. 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. The Medical Director Associate is responsible for providing day-to-day guidance, support, and leadership for clinical and/or quality activities under the guidance of a Medical Director. May be responsible for supporting one or more Medical Directors in ensuring clinical integrity of broad and significant clinical programs. May perform clinical review. How you will make an impact: May provide clinical guidance for programs. Supports clinicians to ensure timely and consistent responses to members and providers. Conducts peer-to-peer clinical reviews with attending physicians or other ordering providers to discuss review determinations, and patients’ office visits with providers and external physicians. May conduct peer-to-peer clinical appeal case reviews with attending physicians or other ordering providers to discuss review determinations. May assist in the practitioner appeal reviews, appropriateness criteria reviews, medical technology assessments, setting and implementing QI initiatives, and practitioner/provider credentialing. Under direction, may be responsible for the administration of medical services for company health plans including medical policies. Serves as a resource and consultant to other areas of the company. May interpret existing medical policy. May be required to represent the company to external entities and/or serve on internal and/or external committees.

Requirements

• Requires MD or 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.
• 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 5 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.

Nice To Haves

• Ability to obtain a Pennsylvania and potentially other medical licenses upon hire.
• Child and Adolescent board certification preferred.
• Utilization management experience preferred.

Responsibilities

• May provide clinical guidance for programs.
• Supports clinicians to ensure timely and consistent responses to members and providers.
• Conducts peer-to-peer clinical reviews with attending physicians or other ordering providers to discuss review determinations, and patients’ office visits with providers and external physicians.
• May conduct peer-to-peer clinical appeal case reviews with attending physicians or other ordering providers to discuss review determinations.
• May assist in the practitioner appeal reviews, appropriateness criteria reviews, medical technology assessments, setting and implementing QI initiatives, and practitioner/provider credentialing.
• Under direction, may be responsible for the administration of medical services for company health plans including medical policies.
• Serves as a resource and consultant to other areas of the company.
• May interpret existing medical policy.
• May be required to represent the company to external entities and/or serve on internal and/or external committees.

Benefits

• In addition to your salary, 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).
• We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

What This Job Offers

• Job Type: Full-time
• Career Level: Director
• Education Level: Ph.D. or professional degree
• Number of Employees: 5,001-10,000 employees