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Medical Director

Location : Virtual - This role enables associates to work virtually full-time, except for required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be considered.

_Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless accommodation is granted as required by law_

The Medical Director is responsible for the administration of medical services to ensure members receive appropriate, cost-effective care. This position is within Elevance Health's National Accounts line of business, which manages the health plans of some of the nation's largest companies, representing more than six hundred clients and ten million lives. The Medical Director may develop and implement programs to improve quality, cost, and outcomes; provide clinical consultation and serve as a clinical and strategic advisor to enhance clinical operations; and identify cost-of-care opportunities that increase value for clients and members.

Primary duties may include, but are not limited to:

+ Works independently with oversight from the immediate manager.

+ Responsible utilization management as well as support to the care management nursing staff of the physician's national client(s).

+ Provides guidance for clinical operational aspects for the client(s).

+ Conducts peer-to-peer clinical reviews with attending physicians to discuss review determinations.

+ Requires two two-week blocks of primary/back up call per year to maintain regulatory turn-around-time during non-business hours when required. This responsibility is shared equitably among the other Operational Medical Directors

+ Serves as a resource and consultant for other areas of the company.

+ Represents the company to external entities (clients) and/or serve on internal and/or external committees.

+ Interprets medical policies and clinical guidelines.

+ Directs, and implements clinical activities that impact healthcare quality, cost, and outcomes.

+ Identifies and develops opportunities for innovation to increase effectiveness and quality.

Requirements:

MD/DO and board certification approved by one of the following certifying boards is required, where applicable to duties being performed, 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. 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. Minimum of 10 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.

Preferred Experience and skill set:

+ Prior experience working within a health plan or involvement with hospital-based utilization review activities.

+ Oncology, Genetic Testing specialty review experience.

+ Pediatric specialty review experience.

+ Surgical specialty review experience.

+ Internal Medicine specialties review experience.

For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $247,840- $427,524

Locations: California; Illinois; Maryland; Nevada; New York; Virginia

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.

*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. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, paid time off, stock, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law.

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded u...

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