Medical Director for Plan Performance

Medical Director for Plan Performance

Join us in a dynamic and flexible work environment where you can thrive while making a difference! In this role, you will have the opportunity to work virtually full-time, with occasional required in-person training sessions to enhance your skills and ensure effective collaboration with your team. Please note that candidates not within a reasonable commuting distance from the designated locations will not be considered for employment unless legally accommodated.

The Medical Director for Plan Performance acts as a key leader overseeing the medical administration of individual ACA health plans across 17 states. In this role, you will manage medical policies and clinical guidelines to drive quality and cost-effective care. You will also play a vital role in directing cost of care initiatives and collaborating closely with market plan presidents during regulatory meetings.

Key Responsibilities :

• Support the Medical Management staff in ensuring timely and consistent communication with members and providers.
• Guide clinical operational aspects of health programs.
• Conduct peer-to-peer clinical reviews with attending physicians or other providers to discuss outcomes and assessment determinations.
• Review clinical appeal cases and engage in discussions with healthcare providers.
• Develop and interpret medical policies and clinical guidelines, adapting them to reflect advancements in healthcare.
• Lead initiatives to implement innovative clinical and non-clinical activities that enhance care efficiency and effectiveness.
• Identify opportunities for innovation to elevate quality and service delivery.
• Share expertise and best practices with other medical directors across regions.
• Participate in or lead company committees and represent the organization to external stakeholders.

Minimum Qualifications :

Preferred Skills and Experience :

This position offers a competitive salary range of $262,752 to $450,432, depending on your experience and location.

Elevance Health provides a robust benefits package, including health, dental, and vision plans, paid time off, 401(k) contributions, and opportunities for equity stock purchase, among other incentives.

The health and safety of our associates are paramount. Therefore, all new candidates in certain roles must become vaccinated against COVID-19 and Influenza unless a valid exemption is provided.

We are proud to be an Equal Employment Opportunity employer, committed to diversity and inclusion. We welcome qualified candidates regardless of their background.