Virtual Medical Director Lead Clinical Programs & Innovation

Elevance Health, Inc.; Chicago (IL); Remote; USD 273.000 - 428.000; Vollzeit

Zusammenfassung

Elevance Health, a Fortune 25 health company, seeks a Medical Director – Ameriben to oversee clinical programs, ensure cost-effective care, and advise on clinical operations. The role requires MD/DO with board certification and extensive clinical experience, with hybrid/virtual work options and occasional in-person sessions.

The candidate will lead clinical reviews, develop policies, and collaborate across departments to improve quality and outcomes, while providing strategic medical leadership.

Qualifikationen

• MD/DO with active unrestricted medical license.
• Board certification by ABMS or AOA where applicable.
• Minimum of 10 years of clinical experience or equivalent background.

Aufgaben

• Supports clinicians to ensure timely responses to members and providers.
• Guides clinical operational aspects of a program.
• Conducts peer-to-peer reviews with attending physicians.
• Serves as consultant to other areas of the company.
• Represents the company to external entities and committees.
• Chairs company committees and interprets medical policies.
• Leads and implements clinical and non-clinical activities to improve quality and cost.
• Identifies opportunities for innovation to increase effectiveness.

Kenntnisse

Utilization management

MCG criteria

Carelon criteria

Anthem criteria

Oncology review

Genetic testing review

Musculoskeletal review

Ausbildung

MD/DO degree

Board certification (ABMS/AOA)

Jobbeschreibung

Elevance Health, a Fortune 25 health company, seeks a Medical Director – Ameriben to oversee clinical programs, ensure cost-effective care, and advise on clinical operations. The role requires MD/DO with board certification and extensive clinical experience, with hybrid/virtual work options and occasional in-person sessions.

The candidate will lead clinical reviews, develop policies, and collaborate across departments to improve quality and outcomes, while providing strategic medical leadership.