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.

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.

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.