Plan Performance Medical Director

Location: This role requires associates to be in-office 3 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered.

Hours: Monday - Friday 8 - 5 pm EST.

Federal Employee Program - FEP, a proud member of the Elevance Health, Inc. family of companies, it is a powerful combination, and the foundation upon which we are creating greater access to care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care.

The Plan Performance Medical Director is pivotal in ensuring the administration of effective and cost-efficient medical care. This role drives strategic direction regarding care costs and is responsible for advancing quality metrics, supporting comprehensive healthcare management, and leading clinical and non-clinical activities to enhance efficiency and effectiveness. The position also emphasizes innovation to improve overall healthcare quality and outcomes.

How you will make an Impact: 

• Collaborate with a team of quality professionals, including Quality Managers/Directors, HEDIS Analysts and staff, as well as clinical leaders of CM and DM, providers, and network partners, to align quality goals and drive performance improvement.

• Provides guidance for clinical operational aspects of a program.

• Implement evidence-based practices to enhance preventive care, chronic disease management, acute hospitalization prevention, and member engagement.

• Manage HEDIS data collection, reporting, and analysis.

• Drive initiatives to improve HEDIS scores, ensuring compliance with national benchmarks.

• Identifies and develops opportunities for innovation to increase effectiveness and quality.

• Provides expertise, captures and shares best practices across regions to other medical directors.

• May chair or serve on company committees, may be required to represent the company to external entities and/or serve on external committees.

• Oversee cost-management strategies and plan directives.

• Monitor and analyze key quality metrics, identify trends, and implement improvement strategies.

• Present findings and actionable strategies to executive leadership.

Minimum Requirements:

• Requires MD or DO and Board certification approved by one of the following certifying boards is required, where applicable to duties being performed, American Board of Medical Specialties (ABMS) or American Osteopathic Association (AOA).

• Requires active unrestricted 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; or any combination of education and experience, which would provide an equivalent background.

Preferred Skills, Capabilities, and Experiences:

• Manage HEDIS data collection, reporting, and analysis to improve scores according to national benchmarks.

• Establish collaborative relationships with internal and external stakeholders to enhance patient care quality.

• Implement evidence-based practices for preventive care, chronic disease management, and member engagement.

• Maintain advanced knowledge of HEDIS, Medication Adherence, and Patient Experience measures.

• Lead teams of quality professionals, including Quality Managers/Directors and HEDIS Analysts.

• Collaborate with clinical leaders, providers, and network partners to align quality goals and drive performance improvements.

• Foster collaborative environments to influence system-wide changes.

• Design and implement clinical programs targeting specific medical conditions across all business lines.

• Collaborate with data and analytics teams to interpret data and identify improvement opportunities.

• Work closely with line-of-business and market leaders to align clinical solutions with health priorities.

• Build and maintain relationships with clinical leaders and provider collaboration groups.

• Promote and share clinical best practices across all business lines to enhance outcomes and efficiency.

• Develop and deliver impactful interventions to improve provider performance and reduce care costs.

• Design national interventions to enhance value-based care.

• Serve as a subject matter expert on clinical quality programs and performance measurement.

• Engage physicians to achieve performance results in value-based care.

For URAC accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills. Travels to worksite and other locations as necessary.

If this job is assigned to any Government Business Division entity, the applicant and incumbent fall under a `sensitive position' work designation and may be subject to additional requirements beyond those associates outside Government Business Divisions. Requirements include but are not limited to more stringent and frequent background checks and/or government clearances, segregation of duties principles, role specific training, monitoring of daily job functions, and sensitive data handling instructions. Associates in these jobs must follow the specific policies, procedures, guidelines, etc. as stated by the Government Business Division in which they are employed.

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.