- 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
- 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
- Works independently with oversight from immediate manager.
- May be responsible for an entire clinical program and/or independently performs clinical reviews.
- The Medical Director typically has program management responsibilities including clinical policy development, program development/implementation, and overseeing clinical/non-clinical activities.}
- Supports clinicians to ensure timely and consistent responses to members and providers.
- Provides guidance for clinical operational aspects of a program.
- Requires MD or DO and Board certification approved by American Board of Psychiatry and Neurology in Child & Adolescent Psychiatry.
- 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 child & adolescent psychiatry 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.
- For URAC accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written, and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
- If this job is assigned to any Government Business Division entity, the applicant and incumbent fall under a sensitive position' work designation and may be subject to additional requirements beyond those associates outside Government Business Divisions
- 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
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Health medical director - Des Moines, United States - Elevance Health
Description
Wellpoint, formerly Amerigroup, is a proud member of Elevance Health's family of brands, offering Medicaid and Medicare plans in several statesWe also provide administrative services to Medicaid plans in partnership with blue cross blue shield plans.
This is an individual contributor role
This position will work a hybrid model (remote and office)
Ideal candidates will live within 50 miles of one of our Elevance Health office locations
The successful candidate will be a Board Certified Child & Adolescent Psychiatrist who will be responsible for appeals reviews within our Medicaid and Medicare programs.
The Behavioral Health Medical Director is responsible for the administration of behavioral health medical services, to ensure the appropriate and most cost effective medical care is receivedMay be responsible for developing and implementing programs to improve quality, cost, and outcomes
May provide clinical consultation and serve as clinical/strategic advisor to enhance clinical operations
May identify cost of care opportunities
May serve as a resource to staff including Medical Director Associates.
How you will make an impact:
{Note:
The following are level distinctions not required for posting
This level may provide oversight, direction, and guidance to Medical Director Associates.
Minimum Requirements:
Associates in these jobs must follow the specific policies, procedures, guidelines, etc
as stated by the Government Business Division in which they are employed.
For candidates working in person or remotely in the below locations, the salary* range for this specific position is $229,120 $412,416
Locations:
California; Colorado; Hawaii; Nevada; New York; Washington State; Jersey City, NJ
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.
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.
Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance HealthAny unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Who We Are
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.
How We WorkAt 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.
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
Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.
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
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
assistance.
Recommended Skills
Administration
Analytical
Behavioral Medicine
Clinical Works
Consulting
Data Processing
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