Plan Performance Medical Director- Washington Medicaid

Elevance Health; Costa Mesa (CA); Remote; USD 150,000 - 220,000; Full time

Job summary

Elevance Health is seeking a Plan Performance Medical Director to lead the administration of medical services and ensure effective care delivery. The role involves collaboration with internal stakeholders and oversight of physical and behavioral health services, requiring an MD or DO with substantial clinical and healthcare administration experience.

Benefits

Maximum flexibility and autonomy

Work virtually full-time

Qualifications

• Minimum 10 years of clinical experience required.
• Experience with health care services for individuals with disabilities preferred.
• Ability to obtain Washington medical license after hire.

Responsibilities

• Lead clinician for the plan and oversee medical policies.
• Conduct peer-to-peer clinical reviews.
• Develop new clinical policies based on healthcare changes.

Skills

Clinical leadership

Healthcare administration

Clinical policy development

Education

MD or DO

Board certification in relevant fields

Job description

Plan Performance Medical Director- Washington Medicaid

Plan Performance Medical Director- Washington Medicaid

2 days ago Be among the first 25 applicants

The Plan Performance Medical Director is responsible for serving as the lead clinician for a plan. Responsible for the administration of medical services for company health plan including the overall medical policies or clinical guidelines of the plan to ensure the most appropriate and cost-effective medical care is received. Drives direction of the plan related to cost of care and other plan directives. Works with the market plan president during meetings with State Regulators and other stakeholders. The PPMD will oversee all physical Health Services provided to individuals. Will also be responsible for working with the CMO, Behavioral Health CMO (BH-CMO), Pharmaceutical director and the whole health director to ensure the integration of physical and Behavioral Health Services and supports. Supports the Medical Management staff 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. Interprets existing policies or clinical guidelines and develops new policies based on changes in the healthcare or medical arena. Leads, develops, directs and implements clinical and non-clinical activities that impact efficient and effective care. Identifies and develops opportunities for innovation to increase effectiveness and quality. Provides expertise, captures and shares best practices across regions to other medical directors. May chair or serve on company committees, may be required to represent the company to external entities and/or serve on external committees. 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). Requires 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. At least five (5) years of experience in directing health care services for frail individuals of any age with physical, intellectual, and/or developmental disabilities is strongly preferred. Washington resident preferred. Ability to obtain a Washington medical license after hire. Board certification in internal medicine, family medicine, or Emergency medicine is preferred. This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. Work schedule: Monday - Friday, 8:00 am to 5:00 pm PST. Weekend rotation: once a month.

Seniority level

• Seniority level

  Director

Employment type

• Employment type

  Full-time

Job function

• Job function

  Health Care Provider

• Industries

  Hospitals and Health Care

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