Medical Director, OBGYN or Pediatric Specialty
Elevance Health
full-time
Posted on:
Location: District of Columbia, New York • 🇺🇸 United States
Visit company websiteSalary
💰 $226,404 - $428,976 per year
Job Level
Lead
About the role
- Administration of physical and/or behavioral health medical services to ensure appropriate and cost-effective medical care
- Develop and implement programs to improve quality, cost, and outcomes
- Provide clinical consultation and serve as clinical/strategic advisor to enhance clinical operations
- Identify cost of care opportunities
- Serve as a resource to staff including Medical Director Associates
- May be responsible for an entire clinical program
- Support clinicians to ensure timely and consistent responses to members and providers
- Provide guidance for clinical operational aspects of a program
- Conduct peer-to-peer clinical reviews and peer-to-peer clinical appeal case reviews with attending physicians or other providers
- Serve as a resource and consultant for other areas of the company
- Represent the company to external entities and/or serve on committees; may chair committees
- Interpret medical policies and clinical guidelines and develop new medical policies based on changes in healthcare
- 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
Requirements
- Requires MD or DO and Board certification approved by ABMS or 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
- A 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, 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
- Background in Obstetrics and Gynecology (OBGYN) or Pediatrics strongly preferred
- 1-2 years Utilization Management experience strongly preferred
- Managed care experience strongly preferred
- Strong oral, written, and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills