Remote Medical Director - Clinical Strategy & Quality

Elevance Health; Meridian (AR); Remote; USD 273,000 - 428,000; Full time

Job summary

Elevance Health is seeking a Medical Director to lead medical services administration and quality initiatives. The role supports clinicians, guides clinical operations, and advises on program development to improve outcomes and cost efficiency.

Ideal candidates have MD/DO with board certification, a full unrestricted license, and 10+ years of clinical experience. The position offers virtual work with some in-person sessions and potential location flexibility within the US.

Qualifications

• MD/DO with board certification required and unrestricted medical license.
• Minimum of 10 years of clinical experience or an equivalent combination of education and experience.

Responsibilities

• 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.
• Represents the company to external entities and/or serves on internal and/or external committees.
• Chairs company committees.
• Interprets medical policies and clinical guidelines.
• Develops and proposes new medical policies based on changes in healthcare.
• Leads, develops, directs, and implements clinical and non-clinical activities that impact healthcare quality, cost, and outcomes.
• Identifies and develops opportunities for innovation to increase effectiveness and quality.
• Evening and Weekend coverage on an equal rotation.

Skills

Utilization management

Clinical policy interpretation

Peer-to-peer reviews

Education

MD/DO and Board certification

Tools

MCG criteria

Carelon criteria

Anthem criteria

Job description

Elevance Health is seeking a Medical Director to lead medical services administration and quality initiatives. The role supports clinicians, guides clinical operations, and advises on program development to improve outcomes and cost efficiency.

Ideal candidates have MD/DO with board certification, a full unrestricted license, and 10+ years of clinical experience. The position offers virtual work with some in-person sessions and potential location flexibility within the US.