What are the responsibilities and job description for the Medicare Medical Director position at Elevance Health?
Elevance Health Medicare Medical Director South Portland, Maine 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, and serving as a clinical / strategic advisor to enhance clinical operations.
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.
- Serves as a resource and consultant to other areas of the company.
- May 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.
Minimum Qualifications :
The salary range for this specific position is $240,576 to $378,048. Elevance Health offers a comprehensive benefits package including merit increases, paid holidays, Paid Time Off, and incentive bonus programs, among others.
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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Salary : $240,576 - $378,048
