What are the responsibilities and job description for the Medical Director- Florida Medicaid position at Elevance Health?
Elevance Health Medical Director - Florida Medicaid
Location : This position will work a hybrid model (remote and office). The ideal candidate must live within 50 miles of one of our Elevance Health PulsePoint locations.
Build the Possibilities. Make an extraordinary impact.
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. Responsibilities include developing and implementing programs to improve quality, cost, and outcomes, providing clinical consultation, and serving as a clinical / strategic advisor to enhance clinical operations.
How you will make an impact :
- Support clinicians to ensure timely and consistent responses to members and providers.
- Provide guidance for clinical operational aspects of a program.
- Conduct peer-to-peer clinical reviews with attending physicians or other providers to discuss review determinations and patients’ office visits.
- Conduct peer-to-peer clinical appeal case reviews with attending physicians or other ordering providers.
- Serve as a resource and consultant to other areas of the company.
- Represent the company to external entities and / or serve on internal and / or external committees.
- Interpret medical policies and clinical guidelines.
- Develop and propose new medical policies based on changes in healthcare.
- Lead, develop, direct, and implement clinical and non-clinical activities that impact healthcare quality, cost, and outcomes.
- Identify and develop opportunities for innovation to increase effectiveness and quality.
Minimum Requirements :
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 in the state of Florida. Minimum of 10 years of clinical experience; or any combination of education and experience that would provide an equivalent background. For Health Solutions and Carelon organizations, a minimum of 5 years of experience providing healthcare is required.
Preferred Skills, Capabilities, and Experiences :
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 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 and lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture.
Benefits :
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs, medical, dental, vision, short and long-term disability benefits, 401(k) match, stock purchase plan, life insurance, wellness programs, and financial education resources.
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. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation.
Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to any status or condition protected by applicable federal, state, or local laws.
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