National Solution Medical Director

3 weeks ago

Palo Alto, California, United States Elevance Health Full time

A proud member of the Elevance Health family of companies, Carelon Medical Benefits Management, formerly AIM Specialty Health, is a benefit-management leader in Illinois. Our platform delivers significant cost-of-care savings across an expanding set of clinical domains, including radiology, cardiology and oncology.

Carelon Medical Benefits Management is looking to hire a National Medical Director. This high-performing individual contributor will be responsible for serving as a National SolutionMedical Director of the Surgical Solution (all surgeries that are Non-MSK / Non-Vascular), leading the strategic implementation of improving the health of the people we serve, influencing product strategy and design and medical management approaches that impact healthcare quality, cost, and outcomes, and improving access to and usefulness of health improvement tools offered to our health plan customers and members.

How you will make an impact:

  • Develops clinical appropriateness guidelines for the surgical solution.
  • Monitors competitor products and internal medical management capabilities and responds with recommendations for improvement in company models.
  • Contributes to the development of Medical Management and Quality Management strategies; Develops and enhances relevant clinical guidelines.
  • Provides clinical leadership for Utilization Management, Case Management, Disease Management, and Quality Management of Clients in cooperation with solution medical directors and the Chief Medical Officer.
  • Provides clinical expertise in sales planning and participates in the acquisition and retention of clients.
  • Collaborates with HCM leaders to refine and improve provider and medical management services to meet the needs of Clients.
  • Provides clinical expertise to relevant data analytic activities; Provides clinical expertise and strategic insight for solution development and expansion.
  • Communicates medical management trends and recommends company medical management responses to Clients.
  • 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.

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 certifications in a Surgical Specialty and/or General Surgery is required.

Strongly Preferred:

  • Certified with the American Board of Surgery and Subspecialty Surgery and 12+ years of experience preferred.
  • MBA and/or experience in Administrative Medicine, Business Strategy, Product Strategy.
  • Experience with Managed Care, Utilization Management, Prior Auth, and Benefits Management decision support in the Non-MSK, Non-Vascular Surgical Domains.
  • Experience leading teams directly or leading teams in a matrixed environment.
  • Ability to travel 10%.

For candidates working in person or remotely in the below locations, the salary* range for this specific position is $244,800 to $440,640

Locations: California; Colorado; Hawaii; Nevada; New York; Washington State; Jersey City, NJ

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 considered to be 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.

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