LTSS Medical Director- Kansas Medicaid

Elevance Health; United States; Hybrid; USD 220,000 - 260,000; Full time

Job summary

Elevance Health seeks an LTSS Medical Director to lead the administration of medical services for Kansas Medicaid, ensuring high-quality care and efficient operations. The role involves developing programs, conducting clinical reviews, and collaborating with healthcare professionals. A commitment to improving healthcare delivery for frail elderly and those with disabilities is essential.

Benefits

Merit increases

Paid holidays and time off

Incentive bonus programs

401(k) + match

Wellness programs

Qualifications

• Requires MD or DO and Board certification.
• Minimum of 10 years of clinical experience.
• Experience in directing healthcare services for elderly individuals preferred.

Responsibilities

• Oversee administration of behavioral health services.
• Develop and implement quality improvement programs.
• Conduct peer-to-peer clinical reviews and represent the company on committees.

Skills

Clinical consultation

Healthcare administration

Cost management

Program development

Education

MD or DO with Board Certification

Active medical license

Job description

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Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Candidates must live in Kansas or near the KS/MO border.

Work schedule: Monday - Friday, 8:00 am to 5:00 pm CST.

The LTSS 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. 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. Will oversee all primary and physical and Behavioral Health Services provided to individuals receiving LTSS. Will also be responsible for working with the CMO, Behavioral Health CMO (BH-CMO), Pharmaceutical director and the behavior supports director to ensure the integration of physical and Behavioral Health Services and supports and LTSS.

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 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.

Minimum Qualifications:

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.

For Health Solutions and Carelon organizations (including behavioral health) only, minimum of 5 years of experience providing health care is required.

Additional experience may be required by State contracts or regulations if the Medical Director is filing a role required by a State agency.

Preferred Skills, Capabilities, and Experiences:

At least five (5) years of experience in directing health care services for frail elderly or individuals of any age with physical, intellectual, and/or developmental disabilities is strongly preferred.

Kansas resident strongly preferred.

Ability to obtain a Kansas medical license after hire.

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 [e-mail] 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

Seniority level

• Seniority level

  Director

Employment type

• Employment type

  Full-time

Job function

• Job function

  Health Care Provider

• Industries

  Community Services

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