Medical Director responsible for managing clinical operations and providing strategic advice at Elevance Health. Overseeing health services and ensuring quality and cost-effectiveness in care delivery.
Responsibilities
Responsible for the administration of physical and/or behavioral health medical services
Provide clinical consultation and serve as clinical/strategic advisor to enhance clinical operations
Conduct peer-to-peer clinical reviews with attending physicians or other providers to discuss review determinations
Serve as a resource and consultant for other areas of the company
Parses through medical policies and clinical guidelines
Lead, develop, direct, and implement clinical and non-clinical activities that impact health care quality cost and outcomes
Requirements
Requires MD or DO and Board certification approved by one of the following certifying boards is required
Must possess an active unrestricted medical license to practice medicine or a health profession
A minimum of 10 years of clinical experience
For Health Solutions and Carelon organizations (including behavioral health) only, a minimum of 5 years of experience providing health care is required
Experience caring for patients in following specialties: Pediatrics, Family Practice, Emergency Medicine, Internal Medicine, and Physical Medicine are strong preferred
Double board-certified in Pediatrics and Internal Medicine is a plus
3-5 years of Utilization Management Review experience strongly preferred
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