Medical Director - Remote Eligible

Medical Director

Medical Director

Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be considered. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.

Work Schedule: Monday-Friday, PST. Weekend rotation once a month. Candidate must be able to work Pacific Time Zone (PST) hours. Residence in Pacific Time Zone preferred.

The Medical Director is responsible for supporting Elevance Health's Washington Medicaid operations by providing clinical leadership and oversight across utilization management, appeals, and program innovation. This position ensures timely, appropriate, and cost-effective medical care for our members.

How You Will Make An Impact:

• 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.
• May conduct peer-to-peer clinical appeal case reviews with attending physicians or other ordering providers to discuss review determinations.
• Serves as a resource and consultant to other areas of the company.
• May be required to represent the company to external entities and/or serve on internal and/or external committees.
• May chair company committees.
• Interprets medical policies and clinical guidelines.
• May develop and propose new medical policies based on changes in healthcare.
• Leads, develops, directs, and implements clinical and non-clinical activities that impact health care quality cost and outcomes.
• Identifies and develops opportunities for innovation to increase effectiveness and quality.
• Works independently with oversight from immediate manager.
• May be responsible for an entire clinical program and/or independently performs clinical reviews.
• Typically has program management responsibilities including clinical policy development, improvement of quality, cost, and outcomes, program development/implementation, and overseeing clinical/non-clinical activities.

Minimum Qualifications:

• 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.
• Unless expressly allowed by state or federal law, or regulation, must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US military base, vessel or any embassy located in or outside of the US.
• Minimum of 10 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
• For Health Solutions, minimum of 5 years of experience providing health care is required.
• Additional experience may be required by State contracts or regulations if the Medical Director is filing a role required by a State agency.

Preferred Skills, Capabilities and Experiences:

• Medicaid experience.
• Managed Care experience.
• Prior Emergency Room, Family Practice, Internal Medicine or Pediatrics experience.
• Willing to obtain a Washington medical license within a reasonable time upon hire.
• Strong oral, written, and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

For candidates working in person or virtually in the below location(s), the salary range for this specific position is $250,236 to $428,976.

Locations: Costa Mesa, CA, Walnut Creek, CA, Woodland Hills, CA, Las Vegas, NV, Seattle, WA

In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company.

Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance.