Medical Director- Florida Medicaid

Elevance Health - Atlanta, GA

Full-time - Senior

Atlanta, GA

11-50 employees

Insurance Carriers and Related Activities

About the position

The Medical Director for Florida Medicaid is responsible for overseeing the administration of physical and behavioral health medical services, ensuring that members receive appropriate and cost-effective medical care. This role involves developing and implementing programs aimed at improving quality, cost, and outcomes, as well as providing clinical consultation and strategic advice to enhance clinical operations. The Medical Director may also identify cost-saving opportunities and serve as a resource for staff, including Medical Director Associates, while managing entire clinical programs.

Responsibilities

• Supports clinicians to ensure timely and consistent responses to members and providers.
• Provides guidance for clinical operational aspects of a program.
• Conducts peer-to-peer clinical reviews with attending physicians or other providers to discuss review determinations and patients' office visits.
• May conduct peer-to-peer clinical appeal case reviews with attending physicians or other ordering providers.
• Serves as a resource and consultant to other areas of the company.
• May 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.

Requirements

• Requires MD or DO and Board certification approved by ABMS or AOA.
• Must possess an active unrestricted medical license to practice medicine in Florida.
• Minimum of 10 years of clinical experience, or equivalent education and experience.
• For Health Solutions and Carelon organizations, minimum of 5 years of experience providing health care is required.

Nice-to-haves

• Background in a Primary Care field (Family Practice, Internal Medicine, Pediatrics, OB/GYN) is preferred.

Benefits

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