National Accounts Medical Director at Elevance Health

Indianapolis, Indiana, United States

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Not SpecifiedCompensation

Senior (5 to 8 years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, Health InsuranceIndustries

Requirements

MD or DO degree
Board certification approved by the 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
Located in a state or territory of the United States when conducting utilization review or appeals consideration (unless expressly allowed by state or federal law or regulation); cannot be located on a US military base, vessel, or any embassy
Minimum of 10 years of clinical experience, or any combination of education and experience providing an equivalent background
For Health Solutions and Carelon organizations (including behavioral health), minimum of 5 years of experience providing health care (additional experience may be required by State contracts or regulations if filing a role required by a State agency)

Responsibilities

Serve as the Operational Medical Director for care management models for National Account clients
Support the clinical vision and implementation to deliver improvements in the health of people served
Support product strategy/design and medical management approaches impacting health care quality, cost, outcomes, and access to health improvement tools for clients/members
Provide clinical expertise in sales planning and participate in client acquisition and retention for National business as needed
Provide input on clinical relevance to account reporting regarding use of medical services by members
Identify and manage medical utilization trends, emerging trends, and market changes impacting clients and members
Proactively identify issues and develop solutions with account management and Sales RVP Medical Directors
Provide clinical oversight for Utilization Management, Case Management, and Total Population Health of the Clinical Team
Conduct case reviews for utilization and case management issues
Ensure consistent adoption and implementation of all medical policies
Lead multidisciplinary rounds
Perform peer-to-peer outreach for Utilization Management (UM) and Case Management (CM) issues, identifying quality issues
Conduct clinical report reviews, trend management, benefit design consultation, and support overall clinical performance to guarantee success
Support all state-specific requirements for each state where business is conducted

Skills

Utilization Management

Case Management

Population Health Management

Clinical Oversight

Product Strategy

Medical Management

Sales Planning

Account Management

Healthcare Quality

Cost Management

Outcomes Improvement

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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