Medical Director (US)

Elevance Health•Tampa, FL

2d•$247,840 - $427,524•Remote

About The Position

The Medical Director is responsible for the administration of medical services to ensure members receive appropriate, cost-effective care. This position is within Elevance Health’s National Accounts line of business, which manages the health plans of some of the nation’s largest companies, representing more than six hundred clients and ten million lives. The Medical Director may develop and implement programs to improve quality, cost, and outcomes; provide clinical consultation and serve as a clinical and strategic advisor to enhance clinical operations; and identify cost-of-care opportunities that increase value for clients and members.

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.
Minimum of 10 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.

Nice To Haves

Prior experience working within a health plan or involvement with hospital-based utilization review activities.

Responsibilities

Works independently with oversight from the immediate manager.
Responsible utilization management as well as support to the care management nursing staff of the physician’s national client(s).
Provides guidance for clinical operational aspects for the client(s).
Conducts peer-to-peer clinical reviews with attending physicians to discuss review determinations.
Requires two two-week blocks of primary/back up call per year to maintain regulatory turn-around-time during non-business hours when required. This responsibility is shared equitably among the other Operational Medical Directors
Serves as a resource and consultant for other areas of the company.
Represents the company to external entities (clients) and/or serve on internal and/or external committees.
Interprets medical policies and clinical guidelines.
Directs, and implements clinical activities that impact healthcare quality, cost, and outcomes.
Identifies and develops opportunities for innovation to increase effectiveness and quality.