Plan Medical Director- Commercial

Plan Performance Medical Director - New York Commercial

Join to apply for the Plan Performance Medical Director
- New York Commercial role at Elevance Health

This role enables associates to work virtually full-time, with the exception of required in-person training sessions. Candidates must live within commutable distance to our NY or NJ locations.

$262,752 - $450,432 per year

• Leads, develops, directs and implements clinical and non-clinical activities that impact efficient and effective care.
• Supports new and existing customers by delivering clinical insights and recommendations that enhance the value proposition of clinical programs.
• Identifies and develops opportunities for innovation to increase effectiveness and quality.
• Provides expertise, captures and shares best practices across regions to other medical directors.
• Provides guidance for clinical operational aspects of a program.
• Interprets existing policies or clinical guidelines and supports new policies based on changes in the healthcare or medical arena.
• Conducts peer-to-peer clinical reviews with attending physicians or other providers to discuss review determinations.
• May conduct peer-to-peer clinical appeal case reviews with attending physicians or other ordering providers to discuss review determinations.
• May chair or serve on company committees, may be required to represent the company to external entities and/or serve on external committees.
• Travels to worksite and other locations as necessary.

• 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.

• Ability to obtain a New York medical license after hire.
• 3 years of managed care experience preferred.
• Consulting experience preferred.
• Utilization management experience preferred.
• Master's Degree preferred. (MBA, MPH, etc.)

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.

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 elevancehealthj for assistance.