- 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
- This level may provide oversight, direction, and guidance to Medical Director Associates.
- 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.}
- 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 cardiology 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.
- Associates in this role are expected to have strong oral, written, and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
- Requirements include but are not limited to more stringent and frequent background checks and/or government clearances, segregation of duties, principles, role specific training, monitoring of daily job functions, and sensitive data handling instructions.
-
Medical Director
1 week ago
The Oncology Service- Richmond Richmond, United States· The Oncology Service (TOS) is Looking for a Medical Director to Help Lead and Grow Our Well-Established Team of Medical and Radiation Oncologists. · This position would be based out of our Richmond, VA location and would oversee the Richmond team. The Oncology Service has been ...
-
Medical Director
1 week ago
CVS Pharmacy, Inc. Richmond, United StatesReady to take your Medical Director skills to the next level with a Fortune 6 company? Checkout this opportunity with Aetna, a CVS Health company Aetna operates Medicaid managed care plans in sixteen states: Arizona, California, Florida, Illinois, K Medical Director, Director, Me ...
-
Medical Director
1 week ago
The Oncology Service- Richmond Richmond, United States· Position at The Oncology Service- Richmond · The Oncology Service (TOS) is Looking for a Medical Director to Help Lead and Grow Our Well-Established Team of Medical and Radiation Oncologists. · This position would be based out of our Richmond, VA location and would oversee t ...
-
Medical Director
22 hours ago
Virginia Jobs Richmond, United StatesMission or Goal of Unit: At VCU Health Pauley Heart Center, our world-class team takes your heart health personally. Building on our history of innovation in patient care, scientific discovery, diversity and collaboration we improve cardiovascular care for all, while continuously ...
-
Medical Director
23 hours ago
FCS, Inc. Richmond, VA, United States Part timeNEW) Seeking Virginia licensed psychiatrist to serve as Medical Director and collaborating physician for up to 6 PMHNPs. This position may be full or part-time. Responsibilities include facilitation of monthly PMHNP meeting, clinical consultation on complex cases, and overseeing ...
-
Medical Director
1 week ago
United Veterinary Care Richmond, United States Full timeDescription · Position at The Oncology Service- Richmond The Oncology Service (TOS) is Looking for a Medical Director to Help Lead and Grow Our Well-Established Team of Medical and Radiation Oncologists. · This position would be based out of our Richmond, VA location and woul ...
-
Medical Director
1 week ago
BAART Programs Richmond, United StatesAppleGate Recovery is looking for an accountable, process oriented and efficient leader of operations for our clinics. A great Medical Center Director leads a diverse team of physicians, counselors, and auxiliary staff to understand the needs of patients undergoing treatment for ...
-
Center Medical Director
1 week ago
CSL Plasma Richmond, United StatesJob Description Summary · Provides medical oversight to Medical Staff Associates, including the training of other physicians and Medical Staff Associates. Usually serves as the primary center physician registered as the Laboratory Director with the Food and Drug Administration (F ...
-
UM Medical Director
2 weeks ago
Elevance Health Richmond, United States**This position will work a hybrid model (remote and office). Ideal candidates must live within 50 miles of one of our Elevance Health locations.** · The Medical Director is responsible for the administration of physical and/or behavioral health medical services, to ensure the ap ...
-
Medical Director Physician
1 week ago
Central Health Management Richmond, United StatesAbout the job Medical Director Physician Central Health Management, Inc. is seeking a board-certified internal or family medicine physician for a full time Medical Director role in post-acute care in the Richmond, Virginia area. This role offers flexibility of schedule, a base gu ...
-
Medical Director Physician
2 weeks ago
Central Health Management Richmond, United StatesAbout the job Medical Director Physician · Central Health Management, Inc. is seeking a board-certified internal or family medicine physician for a full time Medical Director role in post-acute care in the Richmond, Virginia area. · This role offers flexibility of schedule, a ...
-
UM Medical Director
4 days ago
Elevance Health Richmond, United StatesThis position will work a hybrid model (remote and office). Ideal candidates must live within 50 miles of one of our Elevance Health locations. · The Medical Director is responsible for the administration of physical and/or behavioral health medical services, to ensure the approp ...
-
Clinic Medical Director
1 week ago
Potomac Healthcare Solutions Richmond, United StatesClinic Medical Director - 10 MonthVirginia Union UniversityProvide care to the students and faculty of Virginia Union University About the Position:Potomac Healthcare Solutions is proud to offer a rewarding opportunity to work in the Student Health Services at Virginia Union Univ ...
-
Associate Medical Director
3 days ago
Elevance Health Richmond, United StatesClinical Operations Associate Medical Director · Carelon Medical Benefits Management · Radiology Benefit Management/Utilization Review · A proud member of the Elevance Health family of companies, Carelon Medical Benefits Management, formerly AIM Specialty Health, is a benefit-man ...
-
Clinic Medical Director
1 week ago
Potomac Healthcare Solutions Richmond, United StatesClinic Medical Director - 10 Month · Virginia Union University · Provide care to the students and faculty of Virginia Union University · About the Position: · Potomac Healthcare Solutions is proud to offer a rewarding opportunity to work in the Student Health Services at Virgin ...
-
Psychiatrist/Medical Director
2 weeks ago
Fcs Co Richmond, VA, United States(NEW) Seeking Virginia licensed psychiatrist to serve as Medical Director and collaborating physician for up to 6 PMHNPs. This position may be full or part-time. Responsibilities include facilitation of monthly PMHNP meeting, clinical consultation on complex cases, and overseeing ...
-
Nexus Innovations Richmond Heights, United StatesWe are currently seeking a physician for the position of MEDICAL DIRECTOR OF ORTHOPEDICS AND TRAUMATOLOGY (M/F/D) in the Richmond Heights area, near Nuremberg, for a modern medical center. THE OFFER: * Attractive working conditions in a modern medical center * Outpatient orthoped ...
-
Psychiatrist/Medical Director
23 hours ago
FCS, Inc. Richmond, VA, United States(NEW) Seeking Virginia licensed psychiatrist to serve as Medical Director and collaborating physician for up to 6 PMHNPs. This position may be full or part-time. Responsibilities include facilitation of monthly PMHNP meeting, clinical consultation on complex cases, and overseeing ...
-
Elevance Health Richmond, United States· Health Solutions is focused on ensuring Elevance Health consumers have access to the highest quality, most affordable care possible. The team is responsible for driving strategic cost of care initiatives that deliver greater value, developing and advancing Elevance Health's cl ...
-
Medical Director, Lung Transplant – F67000
5 days ago
VCU Health - MCV Physicians Richmond, United StatesMedical Director of Lung Transplant - F67000 · Virginia Commonwealth University Division of Pulmonary Disease and Critical Care Medicine is seeking candidate Medical Director of Lung Transplant. The successful candidate will lead a multi-disciplinary team in providing comprehensi ...
UM Medical Director - Richmond, United States - Elevance Health
Description
This position will work a hybrid model (remote and office). Ideal candidates must live within 50 miles of one of our Elevance Health locations.
The Medical Director is responsible for the administration of physical and/or behavioral health medical services, to ensure the appropriate and most cost-effective medical care is received.
How you will make an impact:
The following are level distinctions not required for posting.
Minimum requirements:
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.
Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with 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 Work
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.
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.