Plan Performance Medical Director

Plan Performance Medical Director

The Plan Performance Medical Director is responsible for serving as the lead clinician for a plan. Responsible for the administration of medical services for the company health plan including the overall medical policies or clinical guidelines of the plan to ensure the appropriate and most cost effective medical care is received. Drives direction of the plan related to cost of care and other plan directives. Works with the market plan president during meetings with State Regulator.

How you will make an impact:

1. Supports the Medical Management staff to ensure timely and consistent responses to members and providers.
2. Provides guidance for clinical operational aspects of a program.
3. 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.
4. May conduct peer-to-peer clinical appeal case reviews with attending physicians or other ordering providers to discuss review determinations.
5. Interpret existing policies or clinical guidelines and develop new policies based on changes in the healthcare or medical arena.
6. Leads, develops, directs and implements clinical and non-clinical activities that impact efficient and effective care.
7. Identifies and develops opportunities for innovation to increase effectiveness and quality. Provides expertise, captures and shares best practices across regions to other medical directors.
8. May chair or serve on company committees, may be required to represent the company to external entities and/or serve on external committees.

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).
• Requires 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.

Preferred Skills, Capabilities, and Experiences:

• Extensive experience working in managed care leadership strongly preferred.
• Experience supporting and collaborating within the LTSS (Long-Term Services and Support) strongly preferred.
• Associates in this role are expected to have strong oral, written, and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills strongly preferred.
• Travels to worksite and other locations as necessary.

For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $ 226,404 to $428,976.

Locations: New York

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.

* The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.

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.