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Molecular Pathology Medical Director

Elevance Health
Indianapolis, IN Full Time
POSTED ON 2/19/2025
AVAILABLE BEFORE 5/4/2025

Elevance Health Molecular Pathology Medical Director Indianapolis, Indiana Apply Now

Location : Alternate locations may be considered. This position will work a hybrid model (remote and office). The ideal candidate will live within 50 miles of one of our Elevance Health PulsePoint locations.

National Government Services is a proud member of Elevance Health's family of brands. We administer government contracts for Medicare and partner with the Centers for Medicare and Medicaid Services to transform federal health programs.

Schedule : This is a part-time role, working 3 full days a week.

The Molecular Pathology 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.
  • Identifying cost of care opportunities.
  • Serving as a resource to staff including Medical Director Associates.
  • Managing an entire clinical program.

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.
  • 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.
  • Chair company committees and 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 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), a minimum of 5 years of experience providing healthcare is required.
  • This position is part of our NGS (National Government Services) division which, per CMS TDL 190275, requires foreign national applicants meet the residency requirement of living in the United States at least three of the past five years.

    Preferred Skills, Capabilities, and Experiences :

  • Experience in development of policies in the Medicare fee-for-service environment.
  • 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.

    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 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. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.

    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. Elevance Health will also follow all relevant federal, state, and local laws.

    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.

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