National Medical Director for Advancing Imaging Services- Carelon

Elevance Health•Ashburn, IL

27d•$260,080 - $468,144•Hybrid

About The Position

National Medical Director for Advancing Imaging Services- Carelon Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. Alternate locations may be considered. Responsible for serving as a National Medical Director of the Advancing Imaging solution, leading the strategic implementation of improving the health of the people we serve, influencing product strategy and design and medical management approaches that impact health care quality, cost, and outcomes, and improving access to and usefulness of health improvement by identifying, defining, and operationalizing evidence-based clinical appropriateness criteria for radiology services How you will make an impact: Partner with internal knowledge services team to maintain and expand clinical guidelines that define medical necessity criteria for advanced imaging services based on current and accurate interpretation of medical literature and relevant society recommendations. Inform and direct AI tool development to increase accuracy and efficiency of utilization management programs Monitors competitor products and internal medical management capabilities and responds with recommendations for improvement in company models. Contributes to development of Medical Management and Quality Management strategies. Responsible for consistent adoption and implementation of all medical policies. Provides clinical leadership for Utilization Management, Case Management, Disease Management, and Quality Management of National Accounts in cooperation with Regional Health Care Management (HCM) team and Chief Medical Officer. Provides clinical expertise in sales planning and participates in the acquisition and retention of internal and external clients. Collaborates with HCM leaders to refine and improve provider and medical management services to meet the needs of the client stakeholders. Assures the clinical relevance of account reporting regarding use of medical services by members. Communicates medical management trends and recommends company medical management responses to the client stakeholders. Contributes to efforts to establish effective physician and hospital quality and cost profiling and education. Contributes to improved provider relationships and national associations and societies (i.e., AMA, Coalition of Specialty Societies). Represents company at nationally recognized speaking engagements to promote health programs.

Requirements

Requires MD or DO and minimum of 12 years of healthcare experience; or any combination of education and experience, which would provide an equivalent background.
Requires current unrestricted medical licensure in applicable state(s).
Board certification required if applicable to the duties being performed.
Requires experience with population or segment health management and the education and coaching of members on wellness, prevention, and healthy lifestyles.

Nice To Haves

Board certification in radiology or a radiologic subspecialty is strongly preferred.
Knowledge of leading competitive product offerings in the healthcare industry and marketplace standards and managed care knowledge strongly preferred.
Experience working with AI tool development preferred.

Responsibilities

Partner with internal knowledge services team to maintain and expand clinical guidelines that define medical necessity criteria for advanced imaging services based on current and accurate interpretation of medical literature and relevant society recommendations.
Inform and direct AI tool development to increase accuracy and efficiency of utilization management programs
Monitors competitor products and internal medical management capabilities and responds with recommendations for improvement in company models.
Contributes to development of Medical Management and Quality Management strategies.
Responsible for consistent adoption and implementation of all medical policies.
Provides clinical leadership for Utilization Management, Case Management, Disease Management, and Quality Management of National Accounts in cooperation with Regional Health Care Management (HCM) team and Chief Medical Officer.
Provides clinical expertise in sales planning and participates in the acquisition and retention of internal and external clients.
Collaborates with HCM leaders to refine and improve provider and medical management services to meet the needs of the client stakeholders.
Assures the clinical relevance of account reporting regarding use of medical services by members.
Communicates medical management trends and recommends company medical management responses to the client stakeholders.
Contributes to efforts to establish effective physician and hospital quality and cost profiling and education.
Contributes to improved provider relationships and national associations and societies (i.e., AMA, Coalition of Specialty Societies).
Represents company at nationally recognized speaking engagements to promote health programs.