Medical Director
Elevance Health
full-time
Posted on:
Location: California • 🇺🇸 United States
Visit company websiteSalary
💰 $250,236 - $428,976 per year
Job Level
Lead
About the role
- Support Elevance Health’s Washington Medicaid operations by providing clinical leadership and oversight across utilization management, appeals, and program innovation
- Ensure timely, appropriate, and cost-effective medical care for members
- 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 appeal case reviews with attending physicians or other providers
- Serve as a resource and consultant to other areas of the company and represent the company externally when required
- Interpret medical policies and clinical guidelines and develop/propose new medical policies
- Lead, develop, direct, and implement clinical and non-clinical activities impacting quality, cost, and outcomes
- Identify and develop opportunities for innovation to increase effectiveness and quality
- Work independently with oversight from immediate manager and potentially manage entire clinical programs
- Program management responsibilities including clinical policy development, quality improvement, program development/implementation, and oversight of clinical/non-clinical activities
Requirements
- MD or DO degree required
- Board certification approved by ABMS or AOA where applicable
- Active unrestricted medical license to practice medicine or a health profession
- Must be located in a U.S. state or territory when conducting utilization review or appeals (cannot be on a U.S. military base, vessel, or embassy)
- Minimum of 10 years of clinical experience (or any combination of education and experience providing equivalent background)
- For Health Solutions roles, minimum of 5 years providing health care
- Willingness to obtain a Washington medical license within a reasonable time upon hire (preferred)
- Medicaid experience (preferred)
- Managed Care experience (preferred)
- Prior Emergency Room, Family Practice, Internal Medicine or Pediatrics experience (preferred)
- Strong oral, written, and interpersonal communication skills
- Problem-solving, facilitation, and analytical skills
- Ability to work Pacific Time Zone (PST) hours; residence in Pacific Time Zone preferred
- Work schedule: Monday-Friday PST with weekend rotation once a month