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Medical Director – LTSS
Elevance HealthLTSS Medical Director responsible for Kansas Medicaid utilization management. Engaging with clinicians and external stakeholders to ensure quality care for long-term services and supports.
About the role
Key responsibilities & impact- Responsible for utilization management across the Kansas Medicaid population, focusing on long-term services and supports (LTSS)
- Coordinates care and benefits, collaborating with internal teams, and engaging with external stakeholders such as the state and providers
- 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
- May conduct peer-to-peer clinical appeal case reviews
- Serves as a resource and consultant for other areas of the company
- Interprets medical policies and clinical guidelines
- Develops and proposes new medical policies based on changes in healthcare
- Leads, develops, directs, and implements clinical and non-clinical activities that impact health care quality cost and outcomes
- Identifies and develops opportunities for innovation to increase effectiveness and quality
Requirements
What you’ll need- Requires MD or DO and Board certification approved by 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
- 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, minimum of 5 years of experience providing health care is required
- Preferred: Ability to obtain a Kansas medical license
- Preferred: Board certification in any Primary Care Specialty with Geriatrics experience
- Preferred: Five years of experience in directing health care services for frail elderly or individuals with physical, intellectual, and/or developmental disabilities
Benefits
Comp & perks- merit increases
- paid holidays
- Paid Time Off
- incentive bonus programs
- medical benefits
- dental benefits
- vision benefits
- short and long-term disability benefits
- 401(k) +match
- stock purchase plan
- life insurance
- wellness programs
- financial education resources
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
Utilization ManagementClinical ReviewMedical Policy DevelopmentCare CoordinationClinical Operations Guidance
Soft Skills
CollaborationConsultationLeadership
Certifications
Board Certification Approved By ABMS Or AOA