Elevance Health
Manager, Medical Director – Transformation Initiatives
Elevance Health, Columbus, Ohio, United States, 43224
Manager, Medical Director – Transformation Initiatives
Location: This role requires associates to be in-office 3 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance.
The
Manager, Medical Director
will serve as a clinical and strategic advisor to enterprise transformation programs spanning affordability, medical cost management, modernization, and growth initiatives. The Medical Director will work closely with engineering, product, operations, and business leaders to shape transformation strategies, assess clinical and financial impacts, and guide implementation of initiatives that impact providers, members, and clients across the healthcare ecosystem. How you will make an impact: Strategic Clinical Leadership Provide clinical insight and medical guidance across multiple enterprise transformation initiatives, including: Medical Cost Management HealthOS and enterprise data platforms Real-time Decisioning & Analytics (RDA) Cost of Care / Payment Integrity Care Management / Utilization Management (CM/UM) Modernization Provider Networking & Modernization Value-Based Care and Carelon Risk models Carelon Research & Data Commercialization Client Information Insights and CDIP/Consumer Experience Advise on
Teradata/SAS migration and retirement , ensuring data modernization supports clinical and operational needs. Translate complex clinical and regulatory requirements into actionable technical and operational strategies. Program & Initiative Support Partner with SVRO (Strategic Value Realization Office) and enterprise transformation leaders to assess clinical and medical cost implications of strategic initiatives. Evaluate program designs for alignment with quality, safety, and evidence-based clinical practice. Guide affordability-focused programs with a balance of cost containment, care quality, and provider/member experience. Collaboration & Influence Collaborate with engineering, analytics, and product teams to ensure platforms such as HealthOS and RDA incorporate clinical intelligence and deliver actionable insights. Advise Carelon Research and Data Commercialization teams on ethical and clinically appropriate use of healthcare data. Partner with Provider Network leaders to shape modernization strategies that drive value-based outcomes and affordability. Serve as a clinical voice in modernization of CM/UM platforms, ensuring alignment with regulatory mandates and member engagement expectations. Regulatory & Compliance Oversight Ensure compliance with clinical, accreditation, and regulatory standards across transformation programs. Support interpretation of federal/state mandates and advise on clinical implementation strategies. 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 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. Preferred Qualifications: 5+ years of clinical practice experience, with transition into payer, managed care, or healthcare leadership preferred. Experience advising medical cost management, utilization management, payment integrity, or provider performance programs preferred. Strong understanding of healthcare data systems (claims, EHR, analytics platforms) and payer operations preferred. Proven ability to influence cross-functional teams and guide complex, enterprise-level initiatives. Prior leadership in a payer, health plan, or healthcare innovation organization preferred. Familiarity with enterprise platforms such as Teradata, SAS, or cloud-based data ecosystems. Experience in value-based care, population health, and care management program design preferred. Understanding research and data commercialization within healthcare. Ability to communicate effectively with technical, clinical, and executive stakeholders. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws.
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Manager, Medical Director
will serve as a clinical and strategic advisor to enterprise transformation programs spanning affordability, medical cost management, modernization, and growth initiatives. The Medical Director will work closely with engineering, product, operations, and business leaders to shape transformation strategies, assess clinical and financial impacts, and guide implementation of initiatives that impact providers, members, and clients across the healthcare ecosystem. How you will make an impact: Strategic Clinical Leadership Provide clinical insight and medical guidance across multiple enterprise transformation initiatives, including: Medical Cost Management HealthOS and enterprise data platforms Real-time Decisioning & Analytics (RDA) Cost of Care / Payment Integrity Care Management / Utilization Management (CM/UM) Modernization Provider Networking & Modernization Value-Based Care and Carelon Risk models Carelon Research & Data Commercialization Client Information Insights and CDIP/Consumer Experience Advise on
Teradata/SAS migration and retirement , ensuring data modernization supports clinical and operational needs. Translate complex clinical and regulatory requirements into actionable technical and operational strategies. Program & Initiative Support Partner with SVRO (Strategic Value Realization Office) and enterprise transformation leaders to assess clinical and medical cost implications of strategic initiatives. Evaluate program designs for alignment with quality, safety, and evidence-based clinical practice. Guide affordability-focused programs with a balance of cost containment, care quality, and provider/member experience. Collaboration & Influence Collaborate with engineering, analytics, and product teams to ensure platforms such as HealthOS and RDA incorporate clinical intelligence and deliver actionable insights. Advise Carelon Research and Data Commercialization teams on ethical and clinically appropriate use of healthcare data. Partner with Provider Network leaders to shape modernization strategies that drive value-based outcomes and affordability. Serve as a clinical voice in modernization of CM/UM platforms, ensuring alignment with regulatory mandates and member engagement expectations. Regulatory & Compliance Oversight Ensure compliance with clinical, accreditation, and regulatory standards across transformation programs. Support interpretation of federal/state mandates and advise on clinical implementation strategies. 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 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. Preferred Qualifications: 5+ years of clinical practice experience, with transition into payer, managed care, or healthcare leadership preferred. Experience advising medical cost management, utilization management, payment integrity, or provider performance programs preferred. Strong understanding of healthcare data systems (claims, EHR, analytics platforms) and payer operations preferred. Proven ability to influence cross-functional teams and guide complex, enterprise-level initiatives. Prior leadership in a payer, health plan, or healthcare innovation organization preferred. Familiarity with enterprise platforms such as Teradata, SAS, or cloud-based data ecosystems. Experience in value-based care, population health, and care management program design preferred. Understanding research and data commercialization within healthcare. Ability to communicate effectively with technical, clinical, and executive stakeholders. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws.
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