Description
Health Solutions is focused on ensuring Elevance Health consumers have access to the highest quality, most affordable care possible. The team is responsible for driving strategic cost of care initiatives that deliver greater value, developing and advancing Elevance Health’s clinical strategy, building and managing relationships with care providers, and generating health insights through advanced analytics.
Medical Director-Internal Medicine
Responsible for the administration of physical and/or behavioral health medical services, to ensure the appropriate and most cost-effective medical care is received. May be responsible for developing and implementing programs to improve quality, cost, and outcomes. May provide clinical consultation and serve as clinical/strategic advisor to enhance clinical operations. May identify cost of care opportunities. May serve as a resource to staff including Medical Director Associates. May be responsible for an entire clinical program.
Roles and Responsibilities
- 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 with providers and external physicians.
- May conduct peer-to-peer clinical appeal case reviews with attending physicians or other ordering providers to discuss review determinations.
- 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 health care quality cost and outcomes.
- Identifies and develops opportunities for innovation to increase effectiveness and quality.
- This level may provide oversight, direction, and guidance to Medical Director Associates.
- Works independently with oversight from immediate manager.
- May be responsible for an entire clinical program and/or independently performs clinical reviews.
- The Medical Director typically has program management responsibilities including clinical policy development, program development/ implementation, and overseeing clinical/non-clinical activities.
Minimum Requirements
- Requires MD or 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.
- Minimum of 10 years of clinical experience; or any combination of education and experience, which would provide an equivalent background. For Health Solutions and Carelon organizations (including behavioral health) only, minimum of 5 years of experience providing health care is required.
- For Health Solutions and Carelon organizations (including behavioral health) only, minimum of 5 years of experience providing health care is required.
Preferred Skills, Capabilities and Experiences
- Associates in this role are expected to have strong oral, written, and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
- Experience working in Internal Medicine or as a Hospitalist strongly preferred.
- 5-7 yrs leadership experience is strongly preferred.
- Strong background in the area of medical management strongly preferred.
- Ability to work on a state level interfacing with key stakeholders.
