Medical Director-Part-time

Elevance Health•St. Louis, MO

1d•Remote

About The Position

The Medical Director oversees the delivery of physical and/or behavioral health services to ensure members receive appropriate, high-quality, and cost-effective care. This role may lead the design and implementation of initiatives to improve quality, outcomes, and affordability, and provides clinical consultation and strategic guidance to strengthen clinical operations. The Medical Director also identifies cost-of-care opportunities, serves as a clinical resource to staff (including Medical Director Associates), and may hold accountability for an entire clinical program. This position is initially 20 hours per week and includes weekend coverage on a 1:4 rotation for the Pacific Time Zone. Weekly hours may expand in 2027. Attendance at regular operational meetings will be expected. Opportunities to participate and lead interdisciplinary team meetings are available and may be required in the future. Weekly team meetings will require attendance. There are also other business and team-related meetings that will require participation and attendance with regularity (monthly, quarterly).

Requirements

MD/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.
Additional experience may be required by State contracts or regulations if the Medical Director is filing a role required by a state agency.
For Health Solutions and Carelon organizations (including behavioral health) only, minimum of 5 years of experience providing health care is required.
Minimum of 10 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
Associates in this role are expected to have strong oral, written, and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
Associates in these jobs must follow the specific policies, procedures, guidelines, etc. as stated by the Government Business Division in which they are employed.

Nice To Haves

Individuals with experience in Oncology, Pediatrics, or Pain Medicine would be preferred.
Pacific Coast Time zone would be preferred but is not required.

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 with providers and external physicians.
Serves as a resource and consultant for other areas of the company.
Represent the company to external entities and/or serve on internal and/or external committees.
Chair company committees.
Interprets medical policies and clinical guidelines.
Develops and proposes 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.
Works independently with oversight from immediate manager.
May be responsible for an entire clinical program and/or independently performs clinical reviews.
The Medical Director typically has program management responsibilities including clinical policy development, program development/implementation, and overseeing clinical/non-clinical activities