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Medical Director

  • Job Family: Medical and Clinical
  • Type: Full time
  • Date Posted:
  • Anticipated End Date:
  • Reference: JR100156

Location:

  • TN, NASHVILLE

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Description

Sign-on Bonus: $5,000

The Tennessee BH Medical Director is responsible for the administration of behavioral health medical services across Tennessee. Responsibilities include ensuring the appropriate and most cost-effective medical care is received. May be responsible for developing and implementing programs to improve quality, cost, and outcomes. Provides clinical consultation and serve as clinical/strategic advisor to enhance clinical operations. May identify cost of care opportunities. Serves as a resource to staff including other Medical Directors.

Location:  This is a hybrid position and will require 1-2 days per week in the office. Nashville is the preferred location and Tennessee residency is required.

Primary duties may include but are not limited to:

  • 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 patient 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.

  • Collaborates closely with the Executive Director of Behavioral Health

  • 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.

Minimum Requirements:

  • Requires MD or DO and Board certification in Psychiatry from a certifying board recognized by the American Board of Medical Specialties (ABMS), or American Osteopathic Association (AOA).

  • Must possess an active unrestricted Tennessee 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 clinical experience post residency training; or any combination of education and experience, which would provide an equivalent background.

Preferred Skills, Capabilities and Experiences:

  • Additional certification in Child & Adolescent Psychiatry or Addictions Psychiatry highly desirable.

  • Previous experience with cost of care/utilization of care strongly preferred.

  • Population health experience strongly preferred.

  • Associates in this role are expected to have strong oral, written, and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

  • Must be willing to travel to parts of the state on occasion as needed.

  • Must be willing to travel to State Medicaid agency meeting as needed.


 

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of 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. Our values and behaviors are the root of our culture. 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.

Elevance Health operates in a Hybrid Workforce Strategy. 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. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.comfor assistance.

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