Medical Director responsible for clinical consultation, policy development, and quality improvement initiatives for CareSource. Must have an MD or DO and live in Massachusetts.
About the role
- Medical Director for Elevance Health to manage healthcare services and improve clinical outcomes. Responsible for administration, strategy, and operational guidance in the healthcare sector.
Responsibilities
- The Medical Director is responsible for the administration of physical and/or behavioral health medical services, to ensure the appropriate and most cost-effective medical care is received.
- May be responsible for developing and implementing programs to improve quality, cost, and outcomes.
- May provide clinical consultation and serve as clinical/strategic advisor to enhance clinical operations.
- May identify cost of care opportunities.
- May serve as a resource to staff including Medical Director Associates.
- 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, and patients’ office visits with providers and external physicians.
- Interprets medical policies and clinical guidelines.
- Leads, develops, directs, and implements 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, where applicable to duties being performed, American Board of Medical Specialties (ABMS) or American Osteopathic Association (AOA).
- Must possess an active unrestricted medical license to practice medicine or a health profession.
- A minimum of 10 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
- 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: Family Medicine, Emergency Medicine, Internal Medicine, and Physical Medicine are strong preferred.
- Strong oral, written, and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills are strongly preferred.
Benefits
- comprehensive benefits package
- incentive and recognition programs
- equity stock purchase
- 401k contribution
- merit increases
- paid holidays
- Paid Time Off
- incentive bonus programs
- medical, dental, vision
- short and long term disability benefits
- wellness programs
- financial education resources
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Medical Director overseeing administration of health services at Elevance Health. Requires extensive clinical experience and responsibilities in program management and quality improvement.
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