National Medical Director – Autism and Neurodevelopmental Disorders (Solution Medical Director)

Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. Alternate locations may be considered.

The National Medical Director, Autism and Neurodevelopmental Disorders (Solution Medical Director) serves as the clinical subject matter expert (SME) and accountable clinical leader for programs supporting members diagnosed with Autism Spectrum Disorder and other neurodevelopmental conditions across Carelon Health solutions.

This role is responsible for setting clinical standards, ensuring the clinical integrity of program design and implementation, and advancing evidence-based approaches that improve access, quality, safety, and outcomes for members diagnosed with Autism Spectrum Disorder and related neurodevelopmental conditions.

The National Medical Director provides input into network strategy, drives data and outcomes, and develops and implements crisis-reduction and early intervention strategies to improve quality, consistency, and patient safety across the network. As a Solution Medical Director, this role partners across clinical operations, product teams, guideline development teams, and external stakeholders to ensure that clinical expertise is embedded end-to-end—from evidence review and guideline development through implementation in utilization management, care management, and whole-person care programs.

Responsible for leading the strategic implementation of programs designed to improve the health of the people we serve, influencing product strategy and design and medical management approaches that impact health care quality, cost, and outcomes, and improving access to and usefulness of health improvement by identifying, defining, and operationalizing evidence-based clinical appropriateness criteria.

How you will make an impact:

• Partner with internal knowledge services and Guideline Research & Development teams to maintain and expand clinical guidelines that define medical necessity criteria based on current and accurate interpretation of medical literature and relevant specialty society recommendations.
• Inform and direct AI-enabled clinical decision support and automation tools to increase the accuracy, consistency, and efficiency of utilization management programs.
• Monitor competitor products and internal medical management capabilities and respond with recommendations for improvement in company models supporting members diagnosed with Autism Spectrum Disorder and other neurodevelopmental conditions.
• Contribute to development of Medical Management and Quality Management strategies designed to improve outcomes and access to appropriate services.
• Responsible for consistent adoption and implementation of all medical policies and clinical appropriateness criteria across programs.
• Provide clinical leadership for Utilization Management, Case Management, Disease Management, and Quality Management of National Accounts in cooperation with Regional Health Care Management (HCM) teams and the Chief Medical Officer.
• Provide clinical consultation on complex cases and support operational teams to ensure evidence-based guidelines are consistently applied and aligned with original program design.
• Provide clinical expertise in sales planning and participate in the acquisition and retention of internal and external clients.
• Collaborate with HCM leaders to refine and improve provider and medical management services to meet the needs of client stakeholders and improve outcomes for members diagnosed with Autism Spectrum Disorder and related neurodevelopmental conditions.
• Assure the clinical relevance of account reporting regarding the use of medical services by members.
• Communicate medical management trends and recommend company medical management responses to client stakeholders.
• Contribute to efforts to establish effective physician and facility quality and cost profiling and education.
• Contribute to improved provider relationships and engagement with national professional organizations and societies (e.g., APA, AMA, ACAP, CASP, specialty societies focused on neurodevelopmental and behavioral health conditions).
• Represent the company at nationally recognized speaking engagements, medical societies, and industry forums to advance clinical thought leadership and promote innovative health programs. 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.

Minimum Requirements:

• Requires MD or DO 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 Qualifications:

• Board certification in Child and Adolescent Psychiatry, Developmental-Behavioral Pediatrics, or a related specialty preferred.
• Clinical and managed care experience supporting members diagnosed with Autism Spectrum Disorder and other neurodevelopmental conditions preferred.
• Experience contributing to clinical guideline development, medical policy design, or evidence-based utilization management programs preferred.
• Experience working with AI-enabled clinical tools or healthcare technology development preferred.

For candidates working in person or virtually in the below locations, the salary* range for this specific position is $279720.00 to $479520.00.

Location(s): California, Illinois, Maryland, Massachusetts, New York, and New Jersey.

In addition to your salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements).

The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.

* The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education, and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.

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.

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 and Influenza. 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.com for assistance.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.