Medical Director, Utilization & Policy (Hybrid/Remote)

The Elevance Health Companies, Inc.; Cincinnati (OH); Hybrid; USD 180,000 - 240,000; Full time

Benefits offered by this job

Hybrid work model

Competitive benefits

Job summary

Elevance Health is seeking a Medical Director - Individual Segment in the United States for a virtual-first role with required in-person training. The director will oversee clinical policy, program development, and utilization management, with a focus on medical necessity reviews and cost-of-care initiatives.

Eligible candidates must have an MD or DO and board certification and be licensed to practice medicine.

Qualifications

• Requires MD or DO and Board certification by ABMS or AOA.
• Active unrestricted medical license to practice medicine or health profession is required.
• Health Solutions and Carelon organizations require 5+ years of health care experience.

Responsibilities

• Supports clinicians to ensure timely, 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.
• May conduct peer-to-peer clinical appeal case reviews with attending physicians.
• Represents the company to external entities and serves on committees.
• Leads, develops, and implements clinical and non-clinical activities affecting quality and cost.

Skills

MD/DO

Clinical leadership

Utilization management

Policy development

Education

MD/DO

Job description

Elevance Health is seeking a Medical Director - Individual Segment in the United States for a virtual-first role with required in-person training. The director will oversee clinical policy, program development, and utilization management, with a focus on medical necessity reviews and cost-of-care initiatives.

Eligible candidates must have an MD or DO and board certification and be licensed to practice medicine.