Virtual Medical Director — Clinical Strategy & Quality

The Elevance Health Companies, Inc.

Indianapolis (IN)

Remote

USD 248,000 - 428,000

Full time

3 days ago

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Benefits offered by this job

Health benefits

401k + match

Paid holidays

Paid Time Off

Incentive programs

Stock purchase plan

Wellness programs

Disability insurance

Life insurance

Job summary

Elevance Health is seeking a Medical Director to lead medical services administration, ensuring members receive appropriate, cost-effective care. This role sits within Elevance Health’s National Accounts line of business and involves developing programs to improve quality and outcomes, providing clinical consultation and advising on operational improvements.

The position requires strong leadership, utilization review oversight, and collaboration with clients and internal teams to optimize care

Qualifications

MD/DO with ABMS or AOA board certification.
Active unrestricted medical license to practice medicine.
Minimum of 10 years of clinical experience.
Experience within a health plan or hospital-based utilization review activities.
Specialty review experience in Oncology, Genetic Testing, Pediatrics, Surgery and Internal Medicine.

Responsibilities

Works independently with oversight from the immediate manager.
Provides utilization management and supports care management nursing staff.
Offers guidance for clinical operational aspects for the client(s).
Conducts peer-to-peer clinical reviews with attending physicians.
Two two-week blocks of primary/back up call per year for regulatory turnaround during non‑business hours.
Serves as a resource and consultant for other areas of the company.
Represents the company to external entities (clients) and/or serves on internal/external committees.
Interprets medical policies and clinical guidelines.
Directs and implements clinical activities that impact healthcare quality, cost, and outcomes.
Identifies and develops opportunities for innovation to increase effectiveness and quality.