Medical Director- CareBridge

Elevance Health•Nashville, TN

1d•Remote

About The Position

CareBridge Health, a proud member of the Elevance Health family of companies within the Carelon business, aims to enable individuals in home and community-based settings to maximize their health, independence, and quality of life through home care and community-based services. The Medical Director is responsible for collaborating with health plan partners, company nurse practitioners, and an interdisciplinary team to ensure the delivery of high-quality and cost-effective medical care. This role may involve developing and implementing programs to improve quality, cost, and outcomes, as well as providing clinical consultation and serving as a clinical/strategic advisor to enhance clinical operations and quality programs. This position is designed to be virtually full-time, offering maximum flexibility and autonomy, with the exception of required in-person training sessions to ensure essential face-to-face onboarding and skill development. Candidates must be within a reasonable commuting distance from the posting location(s) unless an accommodation is legally granted, though alternate locations may be considered.

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 10 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
For Health Solutions and Carelon organizations (including behavioral health) only, minimum of 5 years of experience providing health care is required.
Additional experience may be required by State contracts or regulations if the Medical Director is filing a role required by a State agency.

Nice To Haves

Family Medicine, Internal Medicine, Med Peds, or Geriatrics specialties preferred.
Medicare and Medicare Advantage knowledge/experience preferred.

Responsibilities

Supports clinicians to ensure timely and consistent responses to members and providers.
Provides guidance for clinical operational aspects of a program.
Serves as a resource and consultant to other areas of the company.
May be required to represent the company to external entities and/or serve on internal and/or external committees.
May chair company committees.
Interprets medical policies and clinical guidelines.
May develop and propose new medical policies based on changes in healthcare.
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.