Medical Director, OBGYN or Pediatric Specialty
Elevance Health
Medical Director
Elevance Health
full-time
Posted on:
Origin: • 🇺🇸 United States • California
Visit company websiteSalary
💰 $250,236 - $428,976 per year
Job Level
Lead
About the role
- Supports clinicians to ensure timely and consistent responses to members and providers
- Provides guidance for clinical operational aspects of a program
- Conducts peer-to-peer clinical reviews with attending physicians or other providers to discuss review determinations and patient office visits
- May conduct peer-to-peer clinical appeal case reviews with attending physicians or other ordering providers to discuss review determinations
- Serves as a resource and consultant to other areas of the company
- May be required to represent the company to external entities and/or serve on internal and/or external committees
- May chair company committees
- Interprets medical policies and clinical guidelines and may develop and propose new medical policies
- Leads, develops, directs, and implements clinical and non-clinical activities impacting health care quality cost and outcomes
- Identifies and develops opportunities for innovation to increase effectiveness and quality
- Works independently with oversight from immediate manager and may be responsible for an entire clinical program and/or independently performs clinical reviews
- Typically has program management responsibilities including clinical policy development, improvement of quality, cost, and outcomes, program development/implementation, and overseeing clinical/non-clinical activities
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
- Minimum of 10 years of clinical experience; or any combination of education and experience, which would provide an equivalent background
- For Health Solutions, 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
- Medicaid experience preferred
- Managed Care experience preferred
- Prior Emergency Room, Family Practice, Internal Medicine or Pediatrics experience preferred
- Willing to obtain a Washington medical license within a reasonable time upon hire
- Strong oral, written, and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills