Plan Performance Medical Director - New York Commercial

Plan Performance Medical Director- New York Commercial

Plan Performance Medical Director- New York Commercial

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. Ideal candidates with live within commutable distance to our NY or NJ locations.

The New York Plan Performance Medical Director serves as the Chief Medical Officer for the health plan's Commercial business. This individual is responsible for oversight of medical services for members including the overall medical policies or clinical guidelines of the plan to ensure that appropriate and most cost-effective medical care is received. They will work closely with the market plan president and leadership team to align clinical operations in pursuit of shared objectives

How You Will Make An Impact:

• Leads, develops, directs and implements clinical and non-clinical activities that impact efficient and effective care.
• Supports new and existing customers by delivering clinical insights and recommendations that enhance the value-proposition of clinical programs.
• Identifies and develops opportunities for innovation to increase effectiveness and quality.
• Provides expertise, captures and shares best practices across regions to other medical directors.
• Provides guidance for clinical operational aspects of a program.
• Interprets existing policies or clinical guidelines and supports new policies based on changes in the healthcare or medical arena.
• Conducts peer-to-peer clinical reviews with attending physicians or other providers to discuss review determinations.
• May conduct peer-to-peer clinical appeal case reviews with attending physicians or other ordering providers to discuss review determinations.
• May chair or serve on company committees, may be required to represent the company to external entities and/or serve on external committees.
• Travels to worksite and other locations as necessary.

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).
• Requires 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.

Preferred Skills, Capabilities, and Experiences:

• Ability to obtain a New York medical license after hire.
• 3 years of managed care experience preferred.
• Consulting experience preferred.
• Utilization management experience preferred.
• Master's Degree preferred. (MBA, MPH, etc.)

For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $262,752 to $ 450,432.

Locations: New Jersey, and 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.

Job Level: Director Equivalent

Workshift: 1st Shift (United States of America)

Job Family: MED > Licensed Physician/Doctor/Dentist

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

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.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state, and local laws.

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. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.