Executive Medical Director leading clinical development of nephrology and cardiometabolic disease therapies at Lilly. Collaborating with global teams in a healthcare leader company to innovate healthcare solutions.
About the role
- Medical Director overseeing Florida Medicare Plans and utilization management for Elevance Health. Collaborating with clinicians for quality care and operational guidance in Florida.
Responsibilities
- Support clinicians to ensure timely and consistent responses to members and providers
- Provide guidance for clinical operational aspects of a program
- Perform utilization management reviews to determine medical necessity and appropriateness of care
- Collaborate with UM nurses and case managers to review inpatient admissions, outpatient procedures, and continued stays
- Provide peer-to-peer discussions with treating physicians to discuss medical necessity decisions and care alternatives
- Ensure timely and accurate completion of reviews in compliance with state and federal regulations, NCQA, and company standards
- Serve as a resource and consultant to other areas of the company
- May represent the company to external entities and/or serve on internal and/or external committees
- Interpret medical policies and clinical guidelines
- May develop and propose new medical policies based on changes in healthcare
- Lead, develop, direct, and implement clinical and non-clinical activities that impact health care quality cost and outcomes
- Identify and develop opportunities for innovation to increase effectiveness and quality
- Expectation for this role also includes weekend and holiday coverage during assigned weekend rotations
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 in Florida
- 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, minimum of 5 years of experience providing health care is required
- Bilingual- Spanish speaking preferred
- Utilization Management case review experience strongly preferred
- Previous experience working for a health plan or managed care organization preferred
- Previous Medicare experience preferred
- Internal/Family Medicine or other adult medicine training preferred
Benefits
- Health insurance
- 401(k) +match
- Paid Time Off
- Paid holidays
- Long term disability benefits
- Short term disability benefits
- Life insurance
- Wellness programs
- Financial education resources
- Incentive bonus programs
Job title
Job type
Experience level
Salary
Not specified
Degree requirement
Location requirements
Medical Director responsible for designing and executing medical strategies for Dermatology at Sanofi. Collaborating across teams to optimize patient care and treatment outcomes.
Medical Director leading clinical research activities in oncology at GSK. Collaborating with experts and managing clinical trials for innovative cancer treatments.
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.
Clinical Director leading early clinical development strategy in Immunology for novel therapeutics. Collaborating across teams and executing studies to validate clinical platforms and targets.
Medical Director ensuring clinical determinations and enhancing care quality at MVP Health Care. Collaborating with teams to improve health care delivery in New York.
Executive Medical Director leading clinical development strategy for nephrology programs at Travere Therapeutics. Responsible for cross - functional leadership and regulatory interactions in rare diseases.
Medical Director responsible for clinical consultation, policy development, and quality improvement initiatives for CareSource. Must have an MD or DO and live in Massachusetts.
Medical Director overseeing administration of health services at Elevance Health. Requires extensive clinical experience and responsibilities in program management and quality improvement.
Medical Director for Elevance Health to manage healthcare services and improve clinical outcomes. Responsible for administration, strategy, and operational guidance in the healthcare sector.