Medical Director

Elevance Health•Tampa, FL

4d•$247,840 - $427,524•Remote

About The Position

The Medical Director administers medical services to help ensure members receive appropriate, cost-effective care. The role is in Elevance Health’s National Accounts line of business, which manages health plans for large companies. The Medical Director 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 position works independently with oversight from the immediate manager. It supports utilization management and care management nursing staff for national clients, 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 Medical Director also serves as a company resource and consultant, represents the company to clients and on committees, and identifies opportunities for innovation. The position requires two two-week blocks of primary or backup call each year, shared equitably with other Operational Medical Directors, to maintain regulatory turnaround times outside business hours when needed. The role is described as virtual and full-time, with required in-person training sessions. Candidates must be within a reasonable commuting distance of the posting location(s), unless an accommodation is granted as required by law. Alternate locations may be considered. The posting identifies a salary range of $247,840–$427,524 for candidates working in California, Illinois, Maryland, Nevada, New York, or Virginia.

Requirements

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

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.
Support utilization management and 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 company areas.
Represent the company to external entities, including 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.
Develop programs and identify opportunities for innovation to improve quality, cost, outcomes, effectiveness, and value.