Virtual Medical Director - Health Plan Clinical Leader

Elevance Health; Chicago (IL); Remote; USD 248,000 - 428,000; Full time

Benefits offered by this job

Comprehensive benefits

Equity stock plan

401(k) matching

Job summary

Elevance Health seeks a Medical Director to oversee medical services for our National Accounts clients, focusing on quality, cost, and outcomes. The role supports clinical operations and provides strategic guidance to improve member care while optimizing cost-of-care opportunities.

The position is remote with required in-person training sessions; occasional travel and alternate locations considered. A board-certified MD/DO with extensive clinical and utilization review experience is required.

Qualifications

• MD/DO with ABMS or AOA board certification and active unrestricted medical license.
• Minimum 10 years of clinical experience or equivalent.
• Experience in health plan or hospital utilization review preferred.

Responsibilities

• Works independently with oversight from the immediate manager.
• Responsible utilization management and support to care management nursing staff of national client(s).
• Provides guidance for clinical operational aspects for the client(s).
• Conducts peer-to-peer clinical reviews with attending physicians to discuss review determinations.
• Requires two two-week blocks of primary/back-up call per year to maintain regulatory turnaround time 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 serve 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.

Skills

Utilization management

Clinical consultation

Quality improvement

Policy interpretation

Cross-functional collaboration

Education

MD/DO with ABMS/AOA board certification

Active unrestricted medical license

Job description

Elevance Health seeks a Medical Director to oversee medical services for our National Accounts clients, focusing on quality, cost, and outcomes. The role supports clinical operations and provides strategic guidance to improve member care while optimizing cost-of-care opportunities.

The position is remote with required in-person training sessions; occasional travel and alternate locations considered. A board-certified MD/DO with extensive clinical and utilization review experience is required.