Elevance Health
Behavioral Health Medical Director - Psychiatrist Appeals
Elevance Health, Saint Louis, Missouri, United States, 63146
Behavioral Health Medical Director – Psychiatrist Appeals
Elevance Health is looking for a Behavioral Health Medical Director to oversee psychiatric appeals and medical services. The role focuses on ensuring cost‑effective, high‑quality care through clinical oversight, policy guidance, and continuous improvement initiatives.
Location:
Virtual full‑time with required in‑person training sessions. Maximum flexibility is provided, but candidates must be within a reasonable commuting distance unless an accommodation is granted as required by law. Alternate locations can be considered.
Work Schedule:
Monday – Friday, plus a half day Saturday rotation once a month.
Responsibilities
Supports clinicians in delivering timely and consistent responses to members and providers.
Provides guidance for clinical operational aspects and conducts peer‑to‑peer clinical appeal case reviews.
Serves as a consultant to other company areas and may represent the company to external ਵਿਚىلى etc.
Interprets medical policies and clinical guidelines; may develop new policies based on changes in healthcare.
Leads, directs, and implements quality improvement initiatives that impact cost and outcomes.
Identifies and implements opportunities for innovation to enhance effectiveness and quality.
Provides oversight and guidance to Medical Director Associates.
Works independently with oversight from the immediate manager.
Manages entire clinical programs and performs clinical reviews as needed.
Manages program development and improvement of quality, cost, and outcomes.
Minimum Qualifications
MD or DO with board certification from ABMS or AOA.
Active unrestricted medical license to practice medicineГУ or health profession.
Located in the United States (excluding military bases or foreign embassies).
Minimum 10 years of clinical experience or equivalent education ORIGINAL.
For Health Solutions and Carelon organizations, at least taage
escaped minimum of 5 years of health care experience.
Additional experience may be required by state contracts or regulations.
Preferred Skills, Capabilities, and Experiences
Child and adolescent psychiatry experience.
Utilization management experience sollicit.
Applied Behavior Analysis (ABA) experience.
Active unrestricted medical license in California, or ability to obtain upon hire.
Salary and Benefits Base pay range:
$274,068 – $428,976 per year .
Additional benefits include: comprehensive benefits package, incentive and recognition programs, equity stock purchase, 401(k) contribution, and other compensation subject to eligibility (see company details for full list).
Equal Employment Opportunity Elevance Health is an Equal Employment Opportunity employer. All qualified applicants receive consideration irrespective of age, citizenship status, color, creed, disability, ethnicity, genetic information, gender, marital status, national origin, race, religion, sex, sexual orientation, veteran status, or other protected class. Accommodations for the application process are available. Applicants with arrest or conviction records will be considered in accordance with applicable laws.
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Location:
Virtual full‑time with required in‑person training sessions. Maximum flexibility is provided, but candidates must be within a reasonable commuting distance unless an accommodation is granted as required by law. Alternate locations can be considered.
Work Schedule:
Monday – Friday, plus a half day Saturday rotation once a month.
Responsibilities
Supports clinicians in delivering timely and consistent responses to members and providers.
Provides guidance for clinical operational aspects and conducts peer‑to‑peer clinical appeal case reviews.
Serves as a consultant to other company areas and may represent the company to external ਵਿਚىلى etc.
Interprets medical policies and clinical guidelines; may develop new policies based on changes in healthcare.
Leads, directs, and implements quality improvement initiatives that impact cost and outcomes.
Identifies and implements opportunities for innovation to enhance effectiveness and quality.
Provides oversight and guidance to Medical Director Associates.
Works independently with oversight from the immediate manager.
Manages entire clinical programs and performs clinical reviews as needed.
Manages program development and improvement of quality, cost, and outcomes.
Minimum Qualifications
MD or DO with board certification from ABMS or AOA.
Active unrestricted medical license to practice medicineГУ or health profession.
Located in the United States (excluding military bases or foreign embassies).
Minimum 10 years of clinical experience or equivalent education ORIGINAL.
For Health Solutions and Carelon organizations, at least taage
escaped minimum of 5 years of health care experience.
Additional experience may be required by state contracts or regulations.
Preferred Skills, Capabilities, and Experiences
Child and adolescent psychiatry experience.
Utilization management experience sollicit.
Applied Behavior Analysis (ABA) experience.
Active unrestricted medical license in California, or ability to obtain upon hire.
Salary and Benefits Base pay range:
$274,068 – $428,976 per year .
Additional benefits include: comprehensive benefits package, incentive and recognition programs, equity stock purchase, 401(k) contribution, and other compensation subject to eligibility (see company details for full list).
Equal Employment Opportunity Elevance Health is an Equal Employment Opportunity employer. All qualified applicants receive consideration irrespective of age, citizenship status, color, creed, disability, ethnicity, genetic information, gender, marital status, national origin, race, religion, sex, sexual orientation, veteran status, or other protected class. Accommodations for the application process are available. Applicants with arrest or conviction records will be considered in accordance with applicable laws.
#J-18808-Ljbffr