Plan Performance Medical Director- Missouri Medicaid Market

Elevance Health•St. Louis, MO

1d•Remote

About The Position

The Plan Performance Medical Director (PPMD) is a trusted clinical partner for the MO Medicaid market. The PPMD will oversee clinical program operations within the health plan. The individual will collaborate closely with executive leadership, including the plan president and nursing leadership, to ensure smooth daily operations. Responsibilities also include monitoring performance trends, addressing cost and quality metrics, supporting compliance with state requirements, and contributing to utilization management efforts when necessary.

Requirements

Requires MD or 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).
Requires active unrestricted medical license to practice medicine or a health profession in Missouri.
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

Board certification in Internal Medicine, Family Medicine, Obstetrics, Pediatrics, or Emergency Medicine preferred.
Managed Care experience, specifically in Medicaid preferred.
Strong analytical abilities, including interpreting utilization and cost trends preferred.
Strong presentation and communication skills, especially for external stakeholder interactions preferred.

Responsibilities

Leads, develops, directs and implements clinical and non-clinical activities that impact efficient and effective care
Supports new and existing customers by delivering clinical insights and recommendations that enhance the value-proposition of clinical programs
Identifies and develops opportunities for innovation to increase effectiveness and quality
Provides expertise; captures and shares best practices across regions
Provides guidance for clinical operational aspects of a program
Interprets existing policies or clinical guidelines and supports new policies based on changes in the healthcare or medical arena
Conducts peer-to-peer clinical reviews with attending physicians or other providers to discuss review determinations.
May chair or serve on company committees, may be required to represent the company to external entities and/or serve on external committees which will required in person meetings.