- Develops clinical appropriateness guidelines for post-acute solutions.
- Monitors competitor products and internal medical management capabilities and responds with recommendations for improvement in company models.
- Contributes to the development of Medical Management and Quality Management strategies. Develops and enhances relevant clinical guidelines.
- Provides clinical leadership for Utilization Management, Case Management, Disease Management, and Quality Management of Clients in cooperation with solution medical directors and the Chief Medical Officer.
- Provides clinical expertise in sales planning and participates in the acquisition and retention of clients.
- Collaborates with HCM leaders to refine and improve provider and medical management services to meet the needs of Clients.
- Provides clinical expertise to relevant data analytic activities.
- Provides clinical expertise and strategic insight for solution development and expansion.
- Provides thought leadership in laboratory medicine and genetic testing.
- Communicates medical management trends and recommends company medical management responses to clients.
- Contributes to efforts to establish effective provider quality and cost profiling and education.
- Contributes to improved provider relationships and national associations and societies.
- Represents the company at nationally recognized speaking engagements to promote health programs.
- Certified with the American Board of Physical Medicine & Rehabilitation or Geriatrics and 12+ years of experience preferred.
- MBA and/or experience in Administrative Medicine, Business Strategy, Product Strategy.
- Experience with managing risk programs, ACO's, IPAs, at risk health systems. Population health management and whole person-end to end risk management.
- Benefits Management decision support experience in the Post-Acute Domain, DME, Home Health, and Wound Care.
- Experience with Clinical guideline research and development, medical necessity, and medical policy.
- Ability to travel ~10%.
- 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.
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National Medical Director - Metairie, United States - Elevance Health
Description
A proud member of the Elevance Health family of companies, Carelon Medical Benefits Management, formerly AIM Specialty Health, is a benefit-management leader in Illinois.
Carelon Medical Benefits Management is looking to hire a National Solution Medical Director for a set of Post Acute Care Solutions.
This high-performing individual contributor will be responsible for serving as a National Solution Medical Director for our Post Acute Solutions Clinical Product Line, overseeing clinical integrity for the service line, supporting the product strategy and design, and implementing medical management approaches that impact healthcare quality, cost, and outcomes.
Additional responsibilities include executing on the product strategy, managing solution performance and improving access to and usefulness of health improvement tools offered to our health plan clients and members.
How you will make an impact:
Requires an MD and minimum of 12 years of healthcare experience; or any combination of education and experience, which would provide an equivalent background.
Requires experience with population or segment health management and the education and coaching of members on wellness, prevention, and healthy lifestyles.
Strongly Preferred:
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.
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.
