Remote Medical Director – Utilization & Policy Leader

Socket.dev; Hillsborough (NC); Hybrid; USD 180,000 - 240,000; Full time

Job summary

Elevance Health is seeking a Medical Director - Individual Segment to guide clinical policy development, program implementation, and utilization management. The role emphasizes collaboration with clinicians to ensure timely responses and evidence-based determinations across member and provider interactions.

The position supports cost-of-care initiatives and may involve participation on internal or external committees. A strong medical background and leadership in healthcare are essential.

Qualifications

• Requires MD or DO with ABMS/AOA board certification where applicable.
• Active unrestricted medical license to practice medicine or a health profession.
• Physician with 10+ years clinical experience, or equivalent combination of education and experience.
• Health solutions and carelon roles may require 5+ years healthcare experience.
• Additional state-specific requirements may apply.

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.
• Represents the company to external entities and/or serves on committees as needed.
• May chair company committees and interpret medical policies and guidelines.
• Leads and implements clinical and non-clinical activities impacting health care quality, cost, and outcomes.
• Identifies opportunities for innovation to improve effectiveness and quality.

Skills

Policy development

Clinical leadership

Utilization management

Communication

Education

MD/DO with board certification

Job description

Elevance Health is seeking a Medical Director - Individual Segment to guide clinical policy development, program implementation, and utilization management. The role emphasizes collaboration with clinicians to ensure timely responses and evidence-based determinations across member and provider interactions.

The position supports cost-of-care initiatives and may involve participation on internal or external committees. A strong medical background and leadership in healthcare are essential.