Medical Director

The Elevance Health Companies, Inc.; Indianapolis (IN); Remote; USD 248,000 - 428,000; Full time

Benefits offered by this job

Health benefits

401k + match

Paid holidays

Paid Time Off

Incentive programs

Stock purchase plan

Wellness programs

Disability insurance

Life insurance

Job summary

Elevance Health is seeking a Medical Director to lead medical services administration, ensuring members receive appropriate, cost-effective care. This role sits within Elevance Health’s National Accounts line of business and involves developing programs to improve quality and outcomes, providing clinical consultation and advising on operational improvements.

The position requires strong leadership, utilization review oversight, and collaboration with clients and internal teams to optimize care

Qualifications

• MD/DO with ABMS or AOA board certification.
• Active unrestricted medical license to practice medicine.
• Minimum of 10 years of clinical experience.
• Experience within a health plan or hospital-based utilization review activities.
• Specialty review experience in Oncology, Genetic Testing, Pediatrics, Surgery and Internal Medicine.

Responsibilities

• Works independently with oversight from the immediate manager.
• Provides utilization management and supports care management nursing staff.
• Offers guidance for clinical operational aspects for the client(s).
• Conducts peer-to-peer clinical reviews with attending physicians.
• Two two-week blocks of primary/back up call per year for regulatory turnaround during non‑business hours.
• Serves as a resource and consultant for other areas of the company.
• Represents the company to external entities (clients) and/or serves on internal/external committees.
• Interprets medical policies and clinical guidelines.
• Directs and implements clinical activities that impact healthcare quality, cost, and outcomes.
• Identifies and develops opportunities for innovation to increase effectiveness and quality.

Skills

Clinical experience

Utilization review

Oncology reviews

Genetic testing reviews

Pediatric reviews

Surgical reviews

Internal Medicine reviews

Education

MD/DO and ABMS/AOA board certification

Job description

Position Title

Medical Director

Location

Virtual - This role enables associates to work virtually full-time, except for 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. 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 accommodation is granted as required by law.

Job Description

The Medical Director is responsible for the administration of medical services to ensure members receive appropriate, cost-effective care. This position is within Elevance Health’s National Accounts line of business, which manages the health plans of some of the nation’s largest companies, representing more than six hundred clients and ten million lives. The Medical Director may develop and implement programs to improve quality, cost, and outcomes; provide clinical consultation and serve as a clinical and strategic advisor to enhance clinical operations; and identify cost‑of‑care opportunities that increase value for clients and members.

Primary Duties

• Works independently with oversight from the immediate manager.
• Responsible utilization management as well as support to the care management nursing staff of the physician’s national client(s).
• Provides guidance for clinical operational aspects for the client(s).
• Conducts peer-to-peer clinical reviews with attending physicians to discuss review determinations.
• Requires two two-week blocks of primary/back up call per year to maintain regulatory turn‑around‑time during non‑business hours when required.
• This responsibility is shared equitably among the other Operational Medical Directors.
• Serves as a resource and consultant for other areas of the company.
• Represents the company to external entities (clients) and/or serve on internal and/or external committees.
• Interprets medical policies and clinical guidelines.
• Directs, and implements clinical activities that impact healthcare quality, cost, and outcomes.
• Identifies and develops opportunities for innovation to increase effectiveness and quality.

Requirements

• MD/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.
• Prior experience working within a health plan or involvement with hospital-based utilization review activities.
• Oncology specialty review experience.
• Genetic Testing specialty review experience.
• Pediatric specialty review experience.
• Surgical specialty review experience.
• Internal Medicine specialties review experience.

Salary

• For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $247,840- $427,524.
• Locations: California; Illinois; Maryland; Nevada; New York; Virginia.

Benefits

• A comprehensive benefits package.
• Incentive and recognition programs.
• Equity stock purchase.
• 401k contribution (all benefits are subject to eligibility requirements).
• Merit increases.
• Paid holidays.
• Paid Time Off.
• 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.
• Financial education resources.
• Other benefits as described.

Job Information

• Job Level: Director Equivalent Workshift: Job Family: MED > Licensed Physician/Doctor/Dentist

Equal Employment Opportunity

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 should submit the following form: Accessibility Accommodation Request Form and a member of the team will be in contact.

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.

Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration.

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