Medical Director

Elevance Health•Indianapolis, IN

20d•Remote

About The Position

The Medical Director administers medical services to ensure members receive appropriate, cost-effective care within Elevance Health’s National Accounts line of business. This business manages health plans for more than 600 clients and 10 million lives. The role may develop and implement programs to improve quality, cost, and outcomes; provide clinical consultation and strategic advice to enhance clinical operations; and identify cost-of-care opportunities that increase value for clients and members. The Medical Director works independently with oversight from the immediate manager and is responsible for utilization management and supporting care management nursing staff for national clients. The position provides clinical operational guidance, conducts peer-to-peer reviews with attending physicians, interprets medical policies and clinical guidelines, and directs clinical activities affecting healthcare quality, cost, and outcomes. The role also serves as a consultant across the company, represents the company to external clients or on committees, and identifies opportunities for innovation. Two two-week blocks of primary or backup call per year are required to support regulatory turnaround times during non-business hours when needed; this duty is shared equitably among the other Operational Medical Directors. The role is described as virtual full-time, except for required in-person training sessions. Alternate locations may be considered, but candidates must be within reasonable commuting distance of the posting location(s), unless an accommodation is granted as required by law. The listed salary range applies to candidates working in person or virtually in California, Illinois, Maryland, Nevada, New York, or Virginia.

Requirements

MD or DO degree.
Board certification approved by the American Board of Medical Specialties (ABMS) or the American Osteopathic Association (AOA), where applicable to duties performed.
Active, unrestricted medical license to practice medicine or a health profession.
At least 10 years of clinical experience, or an equivalent combination of education and experience.
When conducting utilization review or appeals consideration, must be located in a U.S. state or territory, and not on a U.S. military base, vessel, or embassy, unless expressly allowed by state or federal law or regulation.

Nice To Haves

Prior experience working within a health plan or involvement with hospital-based utilization review activities.
Oncology or genetic testing specialty review experience.
Pediatric specialty review experience.
Surgical specialty review experience.
Internal Medicine specialties review experience.

Responsibilities

Administer medical services to ensure members receive appropriate, cost-effective care.
Perform utilization management and support care management nursing staff for national clients.
Provide guidance on clinical operational aspects for clients.
Conduct peer-to-peer clinical reviews with attending physicians to discuss review determinations.
Participate in two two-week blocks of primary or backup call per year to maintain regulatory turnaround times during non-business hours when required.
Serve as a resource and consultant for other areas of the company.
Represent the company to external entities and clients, and serve on internal or external committees.
Interpret medical policies and clinical guidelines.
Direct and implement clinical activities that affect healthcare quality, cost, and outcomes.
Identify and develop opportunities for innovation to improve effectiveness and quality.
Develop and implement programs to improve quality, cost, and outcomes, and identify cost-of-care opportunities that increase value for clients and members.