Medical Director
Elevance Health

Job Info

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JR129636 Medical Director

Responsible for the administration of physical and/or behavioral health medical services, to ensure the appropriate and most cost-effective medical care is received.

Location: This position will work a hybrid model (remote and office) and must live within 50 miles of one of our Pulse Point office locations California.

How will you make an impact:

• May be responsible for developing and implementing programs to improve quality, cost, and outcomes.
  
• May provide clinical consultation and serve as clinical/strategic advisor to enhance clinical operations.
  
• May identify cost of care opportunities.
  
• May serve as a resource to staff including Medical Director Associates.
  
• May be responsible for an entire clinical program.
  
• Supports clinicians to ensure timely and consistent responses to members and providers.
  
• Provides guidance for clinical operational aspects of a program.
  
• Conducts peer-to-peer clinical reviews with attending physicians or other providers to discuss review determinations, and patients' office visits with providers and external physicians.
  
• May conduct peer-to-peer clinical appeal case reviews with attending physicians or other ordering providers to discuss review determinations.
  
• Serves as a resource and consultant to other areas of the company.
  
• May be required to represent the company to external entities and/or serve on internal and/or external committees.
  
• May chair company committees.
  
• Interprets medical policies and clinical guidelines.
  
• May develop and propose new medical policies based on changes in healthcare.
  
• Leads, develops, directs, and implements clinical and non-clinical activities that impact health care quality cost and outcomes.
  
• Identifies and develops opportunities for innovation to increase effectiveness and quality.
  

Minimum 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).]
  
• 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 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.
  
• For Health Solutions and Carelon organizations (including behavioral health) only, minimum of 5 years of experience providing health care is required. Additional experience may be required by State contracts or regulations if the Medical Director is filing a role required by a State agency.
  
• For URAC accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written, and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
  
• If this job is assigned to any Government Business Division entity, the applicant and incumbent fall under a sensitive position' work designation and may be subject to additional requirements beyond those associates outside Government Business Divisions.
  
• Requirements include but are not limited to more stringent and frequent background checks and/or government clearances, segregation of duties, principles, role specific training, monitoring of daily job functions, and sensitive data handling instructions.
  
• Associates in these jobs must follow the specific policies, procedures, guidelines, etc. as stated by the Government Business Division in which they are employed.
  

Preferred Skills, Capabilities, and Experiences:

• Strongly preferred: Experience in handling grievances and appeals.
  

For candidates working in person or remotely in the below location(s), the salary* range for this specific position is $329,360 to $395,232.

Locations: California

In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.

* The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law.

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