Manager Medical Director
This role requires associates to be in-office 3 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered.
Please note that per our policy on hybrid/virtual work , candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.
The Manager Medical Director is responsible for the administration of medical services for company health plans including the overall medical policies of the business unit to ensure the appropriate and most cost-effective medical care is received and for the day-to-day management of medical management staff.
How will you make an impact:
Interpret existing policies and develop new policies based on changes in the healthcare or medical arena.
Lead, develop, direct and implement clinical and non-clinical activities that impact health care quality cost and outcomes.
Identify and develop opportunities for innovation to increase effectiveness and quality.
Serve as a resource and consultant to other areas of the company.
May chair or serve on company committees.
May be required to represent the company to external entities and/or serve on external committees.
Conduct peer clinical and/or appeal case reviews along with peer-to-peer clinical reviews with attending physicians or other ordering providers.
Discuss review determination, provide guidance for clinical operational aspects of the program.
Support the medical management staff ensuring timely.
Consistent responses to members and providers.
Hires, trains, coaches, counsels, and evaluate performance of direct reports.
Directly supervises the management of any assigned staff.
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. Unless expressly allowed by state or federal law, or regulation, must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US military base, vessel or any embassy located in or outside of the US.
Minimum of 10 years of clinical experience: or any combination of education and experience, which would provide an equivalent background.
Preferred Skills, Capabilities and Experiences:
Extensive experience in strategic and clinical oversight, specifically in the realm of grievance and appeals strongly preferred.
Demonstrated proficiency in clinical case writing, with the ability to effectively articulate complex medical information and patient narratives in a clear and concise manner strongly preferred.
Minimum of 2-5 years of experience in Medicare and utilization management, with a proven track record of managing and optimizing healthcare resources effectively strongly preferred.
Extensive experience working in managed care leadership strongly preferred.
Strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills strongly preferred.
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.
Who We Are
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.
How We Work
At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
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.
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. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. 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. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
