Medical Director - Medicare Fee for Service

Elevance Health•Tampa, FL

1d•Hybrid

About The Position

The Medical Director - Medicare Fee for Service role is responsible for the administration of physical and/or behavioral health medical services to ensure appropriate and cost-effective medical care. This role may involve developing and implementing programs to improve quality, cost, and outcomes, providing clinical consultation, and serving as a clinical/strategic advisor to enhance clinical operations. The position may also identify cost of care opportunities and serve as a resource to staff, including other Medical Director Associates. Additionally, the Medical Director may be responsible for an entire clinical program. This is a virtual, full-time position with the exception of required in-person training sessions. Alternate locations may be considered if candidates reside within a commuting distance from an office, but candidates not within a reasonable commuting distance will not be considered unless an accommodation is granted.

Requirements

Requires MD/DO and Board certification approved by the American Board of Medical Specialties (ABMS) or American Osteopathic Association (AOA), where applicable to duties being performed.
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.
Foreign national applicants must meet the residency requirement of living in the United States at least three of the past five years, per CMS TDL 190275.

Nice To Haves

Strong oral, written, and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
MAC experience is a plus.
Medicare Fee For Service experience is a plus.
Board certification in internal medicine, family medicine, hospice/palliative care, or geriatrics is 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.