Medical Director National
Supporting the Post Acute Care line of business
Carelon Benefit Management
Location Flexible, must reside within 50 miles of an Elevance Health office
A proud member of the Elevance Health family of companies, Carelon Post Acute Solutions, formerly myNEXUS, is the leader in health resource optimization, focused on transforming how healthcare is delivered and promoting the advancement of care for the people we serve.
The National Medical Director is responsible for serving as a National Medical Director for the Medical Benefits Management Post-Acute Care service line. This includes leading strategic implementation, influencing product strategy design and medical management approaches that impact health care quality, cost, and outcomes, and improving access to and usefulness of health improvement tools offered to members and clients.
How you will make an impact:
- Monitors competitor products and internal medical management capabilities and responds with recommendations for improvement in company models.
- Contributes to development of Medical Management and Quality Management strategies.
- Responsible for consistent adoption and implementation of all medical policies.
- In cooperation with the Chief Medical Officer, provides clinical leadership for Utilization Management and Quality Management of Medical Benefits Management Post-Acute Care.`
- Provides clinical expertise in sales planning and participates in the acquisition and retention of National Accounts.
- Collaborates with other Carelon leaders to refine and improve provider and medical management services to meet the needs of National Accounts.
- Assures the clinical relevance of account reporting regarding use of medical services by National Accounts members.
- Communicates medical management trends and recommends company medical management responses to National Accounts.
- Contributes to efforts to establish effective physician and hospital quality and cost profiling and education.
- Contributes to improved provider relationships and national associations and societies (i.e., AMA, Coalition of Specialty Societies).
- Represents company at nationally recognized speaking engagements to promote health programs.
- Supports clinical collaboration across Carelon to enhance its program and service offerings.
- Drives innovation that supports greater value and simplifies processes and implementations.
- Supports creation and adoption of clinical guidelines as well as translation of guidelines into algorithms that support efficient decision turn around times.
- Provides clinical support to the client services team and collaborates to create innovative solutions to address client needs and concerns.
- 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 current unrestricted medical licensure in applicable state(s).
- Board certification required if applicable to the duties being performed.
- Requires experience with population or segment health management and the education and coaching of members on wellness, prevention, and healthy lifestyles.
Preferred Skills, Capabilities and Experiences:
- Knowledge of leading competitive product offerings in the healthcare industry and marketplace standards and knowledge of National Accounts and Clients expectations strongly preferred.
- Extensive managed care knowledge strongly preferred.
- Board certification in Physical Medicine and Rehabilitation
- 5 or more years of clinical experience in post-acute setting (inpatient rehab, skilled nursing, and/or long term acute care) preferred.
- MBA/MHA preferred.
- Leadership and/or managing teams expereince strongly preferred.
- Ability to gain license in any state.
Please be advised that Elevance Health only accepts resumes from agencies that have a signed agreement with Elevance Health. Accordingly, Elevance Health is not obligated to pay referral fees to any agency that is not a party to an agreement with Elevance Health. Thus, any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Be part of an Extraordinary Team
Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. A Fortune 20 company with a longstanding history in the healthcare industry, we are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?
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, providing various levels of flexibility while also ensuring that associates have opportunities to connect in-person. Unless in a designated virtual-eligible role and 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 – and Elevance Health approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Elevance Health is able to reasonably accommodate. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health has been named as a Fortune Great Place To Work in 2022, has been ranked for five years running as one of the 2023 World’s Most Admired Companies by Fortune magazine, and is a growing Top 20 Fortune 500 Company. To learn more about our company and apply, please visit us at careers.ElevanceHealth.com. 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 firstname.lastname@example.org for assistance.