Registry Manager
Savista
Manager Medical Director
Elevance Health
full-time
Posted on:
Origin: • 🇺🇸 United States • Ohio
Visit company websiteJob Level
Lead
Tech Stack
Realm
About the role
- The Manager Medical Director administers medical services for company health plans including the overall medical policies of the business unit to ensure the appropriate and most cost-effective medical care is received and for the day-to-day management of medical management staff.
- Interpret existing policies and develop new policies based on changes in the healthcare or medical arena.
- Lead, develop, direct and implement clinical and non-clinical activities that impact health care quality cost and outcomes.
- Identify and develop opportunities for innovation to increase effectiveness and quality.
- Serve as a resource and consultant to other areas of the company.
- May chair or serve on company committees.
- May be required to represent the company to external entities and/or serve on external committees.
- Conduct peer clinical and/or appeal case reviews along with peer-to-peer clinical reviews with attending physicians or other ordering providers.
- Discuss review determination, provide guidance for clinical operational aspects of the program.
- Support the medical management staff ensuring timely. Consistent responses to members and providers.
- Hires, trains, coaches, counsels, and evaluate performance of direct reports.
- Directly supervises the management of any assigned staff.
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: or any combination of education and experience, which would provide an equivalent background.
