Elevance Health
Overview
Position Title:
Medical Director Anticipated End Date:
2025-10-17 Job Description:
Medical Director Note: This role enables associates to work virtually full-time with required in-person training sessions, providing flexibility and autonomy. The hybrid/virtual work policy applies; candidates not within a reasonable commuting distance from the posting location(s) will not be considered unless an accommodation is granted as required by law. The Medical Director is responsible for the administration of physical and/or behavioral health medical services, to ensure the appropriate and most cost-effective medical care is received. 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. How will you make an impact
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 for 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. Works independently with oversight from immediate manager. May be responsible for an entire clinical program and/or independently performs clinical reviews. The Medical Director typically has program management responsibilities including clinical policy development, program development/implementation, and overseeing clinical/non-clinical activities. Minimum Requirements
Requires MD or DO and Board certification approved by ABMS or AOA, where applicable to duties performed. Must possess an active unrestricted medical license to practice medicine or a health profession. 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, unless allowed by law. A minimum of 10 years of clinical experience; or any combination of education and experience that provides an equivalent background. *For Health Solutions and Carelon organizations (including behavioral health) only, a 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.* Preferred Skills, Capabilities and Experiences
1-2 years Utilization Management experience strongly preferred. Strong oral, written, and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills. For candidates working in person or virtually in the below location(s), the salary range is $226,404 to $428,976. Locations:
California & New York In addition to salary, Elevance Health offers a comprehensive benefits package including incentive programs, equity, 401k contribution, and other benefits subject to eligibility requirements. The salary is based on legitimate factors set by the Company and is subject to change. Equal pay for equal work is provided regardless of gender, race, or other protected categories. *The salary range note describes Elevance Health’s good faith belief of compensation range at posting time and may be modified. Actual compensation may vary based on location, experience, education, and skill level.* *If this job is assigned to a Government Business Division entity, additional requirements may apply, including more stringent background checks and government clearances. Policies and procedures of the Government Business Division apply.* Job Level:
Director Equivalent Workshift: Job Family:
MED > Licensed Physician/Doctor/Dentist Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Unsolicited resumes are the property of Elevance Health. Who We Are Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company looking for leaders at all levels who are passionate about making an impact on our members and the communities we serve. How We Work We are creating a culture designed to advance our strategy and promote personal and professional growth. Our values drive our strategy, power business outcomes, and support our associates, members, communities, and business. We offer market-competitive total rewards, including merit increases, paid holidays, PTO, incentive bonus programs, medical/dental/vision, disability benefits, 401(k) + match, stock purchase plan, life insurance, wellness programs, and financial education resources, subject to eligibility. Elevance Health operates with a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates may be required to work at an Elevance Health location at least once per week. Time onsite requirements will be discussed during the hiring process. The health of our associates and communities is a priority. New candidates in patient/member-facing roles may be required to be vaccinated against COVID-19 and Influenza. Accommodation may be provided as required by law. Elevance Health is an Equal Employment Opportunity employer. Qualified applicants will receive consideration without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender, marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status protected by law. Applicants requiring accommodation may contact the health job support team for assistance. Qualified applicants with arrest or conviction records will be considered under applicable laws.
#J-18808-Ljbffr
Position Title:
Medical Director Anticipated End Date:
2025-10-17 Job Description:
Medical Director Note: This role enables associates to work virtually full-time with required in-person training sessions, providing flexibility and autonomy. The hybrid/virtual work policy applies; candidates not within a reasonable commuting distance from the posting location(s) will not be considered unless an accommodation is granted as required by law. The Medical Director is responsible for the administration of physical and/or behavioral health medical services, to ensure the appropriate and most cost-effective medical care is received. 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. How will you make an impact
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 for 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. Works independently with oversight from immediate manager. May be responsible for an entire clinical program and/or independently performs clinical reviews. The Medical Director typically has program management responsibilities including clinical policy development, program development/implementation, and overseeing clinical/non-clinical activities. Minimum Requirements
Requires MD or DO and Board certification approved by ABMS or AOA, where applicable to duties performed. Must possess an active unrestricted medical license to practice medicine or a health profession. 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, unless allowed by law. A minimum of 10 years of clinical experience; or any combination of education and experience that provides an equivalent background. *For Health Solutions and Carelon organizations (including behavioral health) only, a 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.* Preferred Skills, Capabilities and Experiences
1-2 years Utilization Management experience strongly preferred. Strong oral, written, and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills. For candidates working in person or virtually in the below location(s), the salary range is $226,404 to $428,976. Locations:
California & New York In addition to salary, Elevance Health offers a comprehensive benefits package including incentive programs, equity, 401k contribution, and other benefits subject to eligibility requirements. The salary is based on legitimate factors set by the Company and is subject to change. Equal pay for equal work is provided regardless of gender, race, or other protected categories. *The salary range note describes Elevance Health’s good faith belief of compensation range at posting time and may be modified. Actual compensation may vary based on location, experience, education, and skill level.* *If this job is assigned to a Government Business Division entity, additional requirements may apply, including more stringent background checks and government clearances. Policies and procedures of the Government Business Division apply.* Job Level:
Director Equivalent Workshift: Job Family:
MED > Licensed Physician/Doctor/Dentist Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Unsolicited resumes are the property of Elevance Health. Who We Are Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company looking for leaders at all levels who are passionate about making an impact on our members and the communities we serve. How We Work We are creating a culture designed to advance our strategy and promote personal and professional growth. Our values drive our strategy, power business outcomes, and support our associates, members, communities, and business. We offer market-competitive total rewards, including merit increases, paid holidays, PTO, incentive bonus programs, medical/dental/vision, disability benefits, 401(k) + match, stock purchase plan, life insurance, wellness programs, and financial education resources, subject to eligibility. Elevance Health operates with a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates may be required to work at an Elevance Health location at least once per week. Time onsite requirements will be discussed during the hiring process. The health of our associates and communities is a priority. New candidates in patient/member-facing roles may be required to be vaccinated against COVID-19 and Influenza. Accommodation may be provided as required by law. Elevance Health is an Equal Employment Opportunity employer. Qualified applicants will receive consideration without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender, marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status protected by law. Applicants requiring accommodation may contact the health job support team for assistance. Qualified applicants with arrest or conviction records will be considered under applicable laws.
#J-18808-Ljbffr