Medical Director- PathWays for Aging Program at Elevance Health

Indianapolis, Indiana, United States

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Not SpecifiedCompensation

Senior (5 to 8 years), Expert & Leadership (9+ years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, Health InsuranceIndustries

Requirements

MD or DO and Board certification approved by American Board of Medical Specialties (ABMS) or American Osteopathic Association (AOA), where applicable to duties
Active unrestricted medical license to practice medicine or a health profession in the state of Indiana
Must be located in a state or territory of the United States when conducting utilization review or appeals (unless allowed by law/regulation); cannot be on US military base, vessel, or embassy
Candidates must live in Indiana
Minimum of 10 years of clinical experience; or equivalent combination of education and experience
For Health Solutions and Carelon (including behavioral health), minimum of 5 years providing health care (additional experience may be required by state contracts/regulations)
Preferred Qualifications
Geriatrics certification strongly preferred
10+ years of clinical experience with senior/elderly populations
Domiciled in Indiana preferred

Responsibilities

Program management including clinical policy development, program development/implementation, and overseeing clinical/non-clinical activities
Utilization review/management
Developing and implementing programs to improve quality, cost, and outcomes
Providing clinical consultation and serving as clinical/strategic advisor to enhance clinical operations
Identifying cost of care opportunities
Serving as a resource to staff including Medical Director Associates
Responsible for an entire clinical program
Supporting clinicians to ensure timely and consistent responses to members and providers
Providing guidance for clinical operational aspects of a program
Conducting peer-to-peer clinical reviews with attending physicians or providers to discuss review determinations and patients’ office visits
Conducting peer-to-peer clinical appeal case reviews with attending physicians or ordering providers
Serving as a resource and consultant to other areas of the company
Representing the company to external entities and/or serving on internal/external committees
Chairing company committees
Interpreting medical policies and clinical guidelines
Developing and proposing new medical policies based on changes in healthcare
Leading, developing, directing, and implementing clinical and non-clinical activities impacting health care quality, cost, and outcomes
Identifying and developing opportunities for innovation to increase effectiveness and quality

Skills

Utilization Review

Clinical Policy Development

Program Management

Peer-to-Peer Reviews

Quality Improvement

Cost Management

Clinical Consultation

Medical Director Oversight

Elevance Health

Integrated health services and digital platform

About Elevance Health

Elevance Health focuses on enhancing the health of individuals throughout their lives by evolving from a traditional health benefits organization into a comprehensive health partner. The company serves over 118 million people, providing support at every stage of health through an integrated approach that addresses a wide range of health needs. Their services are backed by advanced capabilities and a digital health platform that streamlines access to care. Unlike many competitors, Elevance Health emphasizes a holistic view of health, aiming to redefine health and improve community well-being. The ultimate goal is to make health improvements accessible to everyone.

Indianapolis, IndianaHeadquarters

1944Year Founded

$309.4MTotal Funding

IPOCompany Stage

Enterprise Software, Social Impact, HealthcareIndustries

10,001+Employees

Benefits

Medical, dental, & vision insurance

401(k) + match

Paid holidays

Paid Time Off

Incentive bonus programs

Stock purchase plan

Life insurance

Wellness Programs

Financial education resources

Adoption & Surrogacy Assistance

Dependent-care Flexible Spending Account (DCFSA)

Parental Leave

Parental Transition Week

Critical Caregiving Leave

Risks

Departure of CFO John Gallina may create a gap in financial leadership.

Lawsuit against CMS over MA Star Ratings could lead to financial penalties.

CareBridge integration may face operational challenges, disrupting service delivery.

Differentiation

Elevance Health integrates whole health approach with digital health platform for comprehensive care.

Acquisition of CareBridge enhances home health services within Carelon division.

Strategic partnership with Clayton, Dubilier & Rice aims to innovate primary care delivery.

Upsides

AI integration in home health services can reduce hospital readmissions and improve outcomes.

Predictive analytics support early disease detection, aligning with Elevance's whole health approach.

Telehealth expansion offers opportunities to reach more patients remotely.

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