Elevance Health
Medical Director
Elevance Health, Mendota Heights, Minnesota, United States,
Elevance Health Medical Director Mendota Heights, Minnesota Apply Now
At
Federal Health Products and Services - FHPS , a proud member of the Elevance Health, Inc. family of companies, it’s a powerful combination, and the foundation upon which we’re creating greater access to care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care.Location:
This is a Hybrid position and preferred candidates must reside within 50 miles of an Elevance Health PulsePoint location.Hours:
Monday through Friday 8 am - 5 pm MST, PST or CST.The
Medical Director
is responsible for the administration of physical and/or behavioral health medical services, to ensure the appropriate and most cost-effective medical care is received. May be responsible for developing and implementing programs to improve quality, cost, and outcomes. May provide clinical consultation and serve as clinical/strategic advisor to enhance clinical operations. May identify cost of care opportunities. May serve as a resource to staff including Medical Director Associates. May be responsible for an entire clinical program.How you will make an Impact:Supports clinicians to ensure timely and consistent responses to members and providers.Guides clinical operational aspects of a program.Conducts peer-to-peer clinical reviews with attending physicians or other providers to discuss review determinations and patient's office visits with providers and external physicians.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.May develop and propose 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.Works independently with oversight from immediate manager.May be responsible for an entire clinical program and/or independently perform clinical reviews.The Medical Director typically has program management responsibilities including clinical policy development, program development/implementation, and overseeing clinical/non-clinical activities.Minimum Qualifications:Requires MD or DO and Board certification approved by one of the following certifying boards: 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 (including behavioral health) only, a minimum of 5 years of experience providing health care is required.Unless expressly allowed by state or federal law or regulation, must be located in a state or territory of the United States when conducting a utilization review or an appeals consideration.Preferred Skills, Capabilities, and Experiences:Utilization Management experience is a plus.Ability to meet necessary internet speed requirements and adhere to work-at-home agreements.For URAC-accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written, and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills. If this job is assigned to any Government Business Division entity, the applicant and incumbent fall under a sensitive position's work designation and may be subject to additional requirements beyond those associates outside Government Business Divisions.For candidates working in person or remotely in the below locations, the salary* range for this specific position is $218,232 to $342,936.In addition to your salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the company. The company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.Note:
The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
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At
Federal Health Products and Services - FHPS , a proud member of the Elevance Health, Inc. family of companies, it’s a powerful combination, and the foundation upon which we’re creating greater access to care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care.Location:
This is a Hybrid position and preferred candidates must reside within 50 miles of an Elevance Health PulsePoint location.Hours:
Monday through Friday 8 am - 5 pm MST, PST or CST.The
Medical Director
is responsible for the administration of physical and/or behavioral health medical services, to ensure the appropriate and most cost-effective medical care is received. May be responsible for developing and implementing programs to improve quality, cost, and outcomes. May provide clinical consultation and serve as clinical/strategic advisor to enhance clinical operations. May identify cost of care opportunities. May serve as a resource to staff including Medical Director Associates. May be responsible for an entire clinical program.How you will make an Impact:Supports clinicians to ensure timely and consistent responses to members and providers.Guides clinical operational aspects of a program.Conducts peer-to-peer clinical reviews with attending physicians or other providers to discuss review determinations and patient's office visits with providers and external physicians.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.May develop and propose 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.Works independently with oversight from immediate manager.May be responsible for an entire clinical program and/or independently perform clinical reviews.The Medical Director typically has program management responsibilities including clinical policy development, program development/implementation, and overseeing clinical/non-clinical activities.Minimum Qualifications:Requires MD or DO and Board certification approved by one of the following certifying boards: 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 (including behavioral health) only, a minimum of 5 years of experience providing health care is required.Unless expressly allowed by state or federal law or regulation, must be located in a state or territory of the United States when conducting a utilization review or an appeals consideration.Preferred Skills, Capabilities, and Experiences:Utilization Management experience is a plus.Ability to meet necessary internet speed requirements and adhere to work-at-home agreements.For URAC-accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written, and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills. If this job is assigned to any Government Business Division entity, the applicant and incumbent fall under a sensitive position's work designation and may be subject to additional requirements beyond those associates outside Government Business Divisions.For candidates working in person or remotely in the below locations, the salary* range for this specific position is $218,232 to $342,936.In addition to your salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the company. The company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.Note:
The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
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