Remote Medical Director, Medicaid NC

Elevance Health

Durham (NC)

Hybrid

USD 180,000 - 240,000

Full time

14 days+

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Job summary

Elevance Health is seeking a Medical Director to lead utilization review and clinical programs for North Carolina Medicaid. The role blends clinical excellence with strategic oversight to improve quality, costs, and outcomes.

You will partner with clinicians and operate across care delivery, policy interpretation, and program development. The position supports hybrid/virtual work with in-person onboarding, and requires a valid NC medical license, ABMS/AOA board certification, and at least 10

Qualifications

Must hold an MD or DO with ABMS/AOA board certification where applicable.
Must possess an active unrestricted medical license to practice in North Carolina.
Minimum of 10 years of clinical experience; state contracts may require additional 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 to discuss review determinations.
May conduct peer-to-peer clinical appeal case reviews with attending physicians or other ordering providers to discuss review determinations.
Leads, develops, directs, and implements clinical and non-clinical activities that impact health care quality cost and outcomes.