Medical Director - Medical Policy - Remote Eligible

Medical Director - Medical Policy

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. 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. Alternate locations may be considered.

The Medical Director- Medical Policy is responsible for the administration of medical services for company health plans and helps ensure clinical integrity of broad and significant clinical programs, including the overall medical policies of the enterprise.

How you will make an impact:

• Responsible for active engagement in and development of medical policy across Elevance Health.
• Additional responsibilities may include oversight of preventive health service recommendations as well as credentialing policies.
• This position will also be active in engagement with external specialty societies and other external facing medical professional activities for the company.
• Interprets existing policies and develops new policies based on changes in the healthcare or medical arena.
• Leads, develops, directs and implements clinical and non-clinical activities that impact health care quality cost and outcomes.
• Supports the Medical Policy staff ensuring timely and consistent responses to members and providers.
• Supports coordination with external entities that develop clinical utilization management guidelines used by Company Plans (e.g., MCG Care guidelines, Carelon Medical Benefits Management guidelines and CarelonRx)
• Identifies and develops opportunities for innovation to increase effectiveness and quality.
• Serves as a resource and consultant to other areas of the company.
• May chair or serve on company committees including chair of the National Credentialing Committee.

Minimum 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.
• 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 and Carelon organizations (including behavioral health) only, 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 Qualifications:

• Extensive managed care or Medicare knowledge.
• MPH or MS in Epidemiology preferred, or equivalent experience and knowledge in evidence-based medicine and clinical epidemiology.
• Proficiency in writing preferred.

For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $262,152 to $393,228.

Locations: Illinois

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. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.

Job Level: Director Equivalent

Workshift: 1st Shift (United States of America)

Job Family: MED > Licensed Physician/Doctor/Dentist