Medical Director - Medical Policy

CareBridge-posted 3 months ago
$262,152 - $393,228/Yr
Full-time • Senior
Metairie, LA
251-500 employees
Ambulatory Health Care Services
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The Medical Director- Medical Policy is responsible for the administration of medical services for company health plans and helps ensure clinical integrity of broad and significant clinical programs, including the overall medical policies of the enterprise. 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.

  • Responsible for active engagement in and development of medical policy across Elevance Health.
  • Oversight of preventive health service recommendations as well as credentialing policies.
  • Engagement with external specialty societies and other external facing medical professional activities for the company.
  • 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.
  • Supports the Medical Policy staff ensuring timely and consistent responses to members and providers.
  • Supports coordination with external entities that develop clinical utilization management guidelines used by Company Plans.
  • 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 including chair of the National Credentialing Committee.
  • Requires MD or DO and Board certification approved by one of the following certifying boards: 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.
  • 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, minimum of 5 years of experience providing health care is required.
  • Extensive managed care or Medicare knowledge.
  • MPH or MS in Epidemiology preferred, or equivalent experience and knowledge in evidence-based medicine and clinical epidemiology.
  • Proficiency in writing preferred.
  • Comprehensive benefits package.
  • Incentive and recognition programs.
  • Equity stock purchase.
  • 401k contribution.
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