Medical Director Clinical Programs
1 month ago
This is a remote, individual contributor role and the person in this position must live within 50 miles of an Elevance Health location. Monday - Friday, standard business hours.
The Medical Director Clinical Programs is responsible for designing and implementing clinical programs with specific medical condition focus for all lines of business enterprise wide. Analyzes and interprets data in collaboration with data and analytics to identify opportunities. Partners with LOB (line of business) and Market leaders to ensure clinical solutions align with membership health priorities. Designs and develops national level interventions leveraging existing tools that will drive performance in value-based care in support of the innovation and execution of corporate clinical interventions.
Provides clinical expertise, captures and shares best practices across regions to provider partners as well as the company’s medical directors by way of studying designs, analytics and reporting for clinical quality that drives improved healthcare outcomes.
Accountable for achieving performance results in value-based care by engaging, influencing and supporting physicians.
Works to develop and deliver high impact interventions, supporting content development and practice transformation embedded capabilities to significantly improve provider performance that drive cost of care and improve HEDIS/Stars where applicable.
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).
Must possess an active unrestricted medical license to practice medicine or a health profession.
Consulting experience and/or MBA
Experience with Medicare Advantage STARS or Risk Adjustment
Six Sigma or formal process improvement experience preferred.
Advanced knowledge in health care systems and health policy, quality measures, performance measurement, and quality improvement, and the clinical understanding for clinical quality programs strongly preferred.
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