Oncology Medical Director- Commercial National Division

Elevance Health; Atlanta (GA); Hybrid; USD 252,000 - 379,000; Full time

Job summary

An established industry player is seeking an Oncology Medical Director to lead clinical operations and improve cancer care outcomes. This role involves providing clinical consultation, conducting utilization reviews, and developing oncology programs to enhance quality and cost-effectiveness. The ideal candidate will have extensive clinical experience, an MD or DO, and board certification in oncology. This position offers a hybrid work model, allowing for flexibility while making a significant impact in oncology care management. Elevance Health provides a comprehensive benefits package, ensuring a supportive and rewarding work environment for its employees.

Benefits

Comprehensive benefits package

Incentive and recognition programs

Equity stock purchase

401k contribution

Qualifications

• Requires MD or DO with board certification and active medical license.
• Minimum 10 years of clinical experience required.

Responsibilities

• Provide clinical consultation and strategic advice for oncology care.
• Conduct peer-to-peer clinical reviews and support clinicians.

Skills

Clinical Consultation

Oncology Knowledge

Utilization Review

Case Management

Medical Policy Interpretation

Peer-to-Peer Clinical Review

Education

MD or DO

Board Certification

Active Medical License

Job description

Oncology Medical Director- Commercial National Division

Location: Alternate locations may be considered. This position will work a hybrid model (remote and office). The ideal candidate must live within 50 miles of one of our Elevance Health PulsePoint locations.

The Oncology Medical Director will support our National Account clients in operations with utilization and case management reviews using evidence-based guidelines and be responsible for the administration of health medical services, to ensure the appropriate and most cost-effective medical care is received. This operational work is estimated for approximately 60% for the medical director time/effort.

In addition, the medical director will leverage oncology knowledge with support for cancer care case management, specific provider collaboration, and client-facing activities as related to oncology drivers.

There will be opportunity for direct involvement in developing and implementing oncology programs to improve quality, cost, and outcomes (end to end oncology solution).

How you will make an impact:

• Provide clinical consultation and serve as clinical/strategic advisor to enhance clinical operations as related to oncology care.
• Identify cost of care opportunities through oncology related services.
• May serve as an oncology resource to staff including Medical Director Associates and supporting clinical team.
• Oncology specific work would comprise 40% of the medical director time.
• 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 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.
• 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:

• Oncology board certification strongly preferred.

For candidates working in person or remotely in the below location(s), the salary range for this specific position is $252,032 to $378,048.

Locations: Illinois

In addition to your salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements