Medicare Medical Director

Elevance Health Medicare Medical Director Independence, Ohio Apply Now

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.

Candidates must be able to work Eastern Time Zone hours.

The Medicare 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 may include developing and implementing programs to improve quality, cost, and outcomes, providing clinical consultation, serving as a clinical / strategic advisor, identifying cost of care opportunities, and managing entire clinical programs.

How you will make an impact :

• 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 and patients’ office visits.
• May conduct peer-to-peer clinical appeal case reviews with attending physicians or other ordering providers.
• 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 healthcare quality, cost, and outcomes.
• Identifies and develops opportunities for innovation to increase effectiveness and quality.

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 that would provide an equivalent background. For Health Solutions and Carelon organizations (including behavioral health) only, a minimum of 5 years of experience providing healthcare is required.

The salary range for this specific position is $240,576 to $378,048. In addition to your salary, Elevance Health offers a comprehensive benefits package, incentive and recognition programs, equity stock purchase, and 401k contributions (all benefits are subject to eligibility requirements).

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

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.

Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws.

J-18808-Ljbffr

Salary : $240,576 - $378,048