Regional Vice President overseeing account management and clinical guidance for national clients at Elevance Health. Collaborating with sales and account management teams to enhance healthcare quality and outcomes.
About the role
- Medical Director responsible for managing clinical operations and providing strategic advice at Elevance Health. Overseeing health services and ensuring quality and cost-effectiveness in care delivery.
Responsibilities
- Responsible for the administration of physical and/or behavioral health medical services
- Provide clinical consultation and serve as clinical/strategic advisor to enhance clinical operations
- Conduct peer-to-peer clinical reviews with attending physicians or other providers to discuss review determinations
- Serve as a resource and consultant for other areas of the company
- Parses through medical policies and clinical guidelines
- Lead, develop, direct, and implement clinical and non-clinical activities that impact health care quality cost and outcomes
Requirements
- Requires MD or DO and Board certification approved by one of the following certifying boards is required
- Must possess an active unrestricted medical license to practice medicine or a health profession
- A minimum of 10 years of clinical experience
- For Health Solutions and Carelon organizations (including behavioral health) only, a minimum of 5 years of experience providing health care is required
- Experience caring for patients in following specialties: Pediatrics, Family Practice, Emergency Medicine, Internal Medicine, and Physical Medicine are strong preferred
- Double board-certified in Pediatrics and Internal Medicine is a plus
- 3-5 years of Utilization Management Review experience strongly preferred
Benefits
- comprehensive benefits package
- incentive and recognition programs
- equity stock purchase
- 401k contribution
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