Remote Medical Director: Policy & Utilization Leader

Elevance Health; Cincinnati (OH); Hybrid; USD 230,000 - 320,000; Full time

Benefits offered by this job

Health benefits

401(k) + match

Stock purchase plan

Job summary

Elevance Health seeks a Medical Director to lead clinical policy development, program implementation, and utilization management activities. responsibilities include reviewing cases for medical necessity, determining benefits, and guiding clinical operations while collaborating with clinicians and external partners.

The role emphasizes program development, cost-of-care initiatives, and opportunities to influence policy within a hybrid work model and a large health system.

Qualifications

• MD or DO with active medical license and board certification (ABMS/AOA).
• Minimum of 10 years of clinical experience; for Health Solutions and Carelon, 5 years in healthcare.
• Experience in managed care and utilization management is preferred.

Responsibilities

• Support clinicians to ensure timely, consistent responses to members and providers.
• Provide guidance for clinical operational aspects of a program.
• Conduct peer-to-peer clinical reviews with attending physicians or other providers.
• May participate in committee work and represent the company externally.

Skills

Clinical leadership

Utilization management

Peer-to-peer reviews

Policy interpretation

Education

MD/DO

Board certification ABMS/AOA

Job description

Elevance Health seeks a Medical Director to lead clinical policy development, program implementation, and utilization management activities. responsibilities include reviewing cases for medical necessity, determining benefits, and guiding clinical operations while collaborating with clinicians and external partners.

The role emphasizes program development, cost-of-care initiatives, and opportunities to influence policy within a hybrid work model and a large health system.