Plan Performance Medical Director- Wisconsin and Missouri Markets

Elevance Health•St. Louis, MO

1d•Hybrid

About The Position

The Plan Performance Medical Director (PPMD) is a trusted clinical partner for the WI and MO markets. The PPMD will support sales teams to grow and retain business. PPMDs represent our population health strategy in our communities and build provider partnerships and local government relationships as well as respond to new regulations and other market concerns. The PPMD is a critical member of the market leadership team, advising and collaborating with the Plan President, Network teams, and other functions to improve both affordability and member and provider experience. PPMDs assess local trends in utilization and develop and implement Cost of Care initiatives.

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.
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

Leadership activities in care or utilization management preferred.
Managed care or population health management experience strongly 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