UM Medical Director

3 months ago

Chicago, United States Elevance Health Full time

Job Description

:

This position will work a hybrid model (remote and office). Ideal candidates must live within 50 miles of one of our Elevance Health locations.

The Medical Director is responsible for the administration of physical and/or behavioral health medical services, to ensure the appropriate and most cost-effective medical care is received. May be responsible for developing and implementing programs to improve quality, cost, and outcomes. May provide clinical consultation and serve as clinical/strategic advisor to enhance clinical operations. May identify cost of care opportunities. May serve as a resource to staff including Medical Director Associates. May be responsible for an entire clinical program.

How you will make an impact:

Supports clinicians to ensure timely and consistent responses to members and providers. Provides guidance for clinical operational aspects of a program. Conducts peer-to-peer clinical reviews with attending physicians or other providers to discuss review determinations, and patients office visits with providers and external physicians. May conduct peer-to-peer clinical appeal case reviews with attending physicians or other ordering providers to discuss review determinations. Serves as a resource and consultant to other areas of the company. May be required to represent the company to external entities and/or serve on internal and/or external committees. May chair company committees. Interprets medical policies and clinical guidelines. May develop and propose new medical policies based on changes in healthcare. Leads, develops, directs, and implements clinical and non-clinical activities that impact health care quality cost and outcomes. Identifies and develops opportunities for innovation to increase effectiveness and quality. {Note: The following are level distinctions not required for posting. This level may provide oversight, direction, and guidance to Medical Director Associates. Works independently with oversight from immediate manager. May be responsible for an entire clinical program and/or independently performs clinical reviews. The Medical Director typically has program management responsibilities including clinical policy development, program development/implementation, and overseeing clinical/non-clinical activities.}

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).  Must possess an 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 cardiology clinical experience; or any combination of education and experience, which would provide an equivalent background. For Health Solutions and Carelon organizations (including behavioral health) only, minimum of 5 years of experience providing health care is required. Additional experience may be required by State contracts or regulations if the Medical Director is filing a role required by a State agency.

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.

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.

Job Level:

Director Equivalent

Workshift:

1st Shift (United States of America)

Job Family:

MED > Licensed Physician/Doctor/Dentist

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. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.

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. 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 for assistance.

  • Onsite Nurse Liaison UM

    3 months ago

    Chicago, United States Solving IT Full time

    One of the largest health insurers in the nation is focused on continuously building an industry-defining, world-class IT capability. Healthcare is forever evolving, especially due to emerging technologies, making this a great experience to add to your resume. Come join their winning team!This Contract-to-Hire role as an Onsite Nurse Liaison UM & QR in...

  • Onsite Nurse Liaison UM

    3 months ago

    Chicago, United States Solving IT Full time

    One of the largest health insurers in the nation is focused on continuously building an industry-defining, world-class IT capability. Healthcare is forever evolving, especially due to emerging technologies, making this a great experience to add to your resume. Come join their winning team!This Contract-to-Hire role as an Onsite Nurse Liaison UM & QR in...

  • Center Medical Director

    3 weeks ago

    Chicago, United States Oak Street Health Full time

    DescriptionCompany: Oak Street Health Title: Center Medical Director Location: Oak Street Health: Ashburn Center - 3348 W. 87th St. Chicago, IL 60652Role Description: The purpose of the Center Medical Director role at Oak Street Health is to lead the clinical team at their center in providing the best patient care and a great place to work in order to keep...

  • Center Medical Director

    1 month ago

    Chicago, United States Oak Street Health Full time

    Company: Oak Street Health Title: Center Medical Director Location: Oak Street Health: Ashburn Center - 3348 W. 87th St. Chicago, IL 60652 Role Description: The purpose of the Center Medical Director role at Oak Street Health is to lead the clinical team at their center in providing the best patient care and a great place to work in order to keep patients...

  • Center Medical Director

    4 days ago

    Chicago, United States Oak Street Health Full time

    Company: Oak Street Health Title: Center Medical Director Location: Oak Street Health: Ashburn Center - 3348 W. 87th St. Chicago, IL 60652 Role Description: The purpose of the Center Medical Director role at Oak Street Health is to lead the clinical team at their center in providing the best patient care and a great place to work in order to keep...

  • Center Medical Director

    4 weeks ago

    Chicago, United States Oak Street Health Full time

    Company: Oak Street HealthTitle: Center Medical DirectorLocation: Oak Street Health: Ashburn Center - 3348 W. 87th St. Chicago, IL 60652Role Description: The purpose of the Center Medical Director role at Oak Street Health is to lead the clinical team at their center in providing the best patient care and a great place to work in order to keep patients...

  • Physician Leadership Opportunity in Primary Care Medical Director Role

    2 days ago

    Chicago, Illinois, United States Britt Medical Search Full time

    The Medical Director will play a pivotal role in shaping the future of primary care at Britt Medical Search. As a seasoned physician leader, you will be responsible for guiding our clinicians in their neighborhood of clinics, setting an example for thoughtful primary care practices, and serving as a mentor, coach, and advisor to providers.Candidate...

  • Center Medical Director

    1 month ago

    Chicago, United States Oak Street Health Full time

    Description Company: Oak Street Health Title: Center Medical Director Location: Oak Street Health: Ashburn Center - 3348 W. 87th St. Chicago, IL 60652 Role Description: The purpose of the Center Medical Director role at Oak Street Health is to lead the clinical team at their center in providing the best patient care and a great place to work in order to...

  • Center Medical Director

    1 month ago

    Chicago, United States Cross Country Workforce Solutions Group Full time

    Join our Chicago, IL Team!Medical Director of PACESalary Range $209,000 to $260,000 annually + benefits!Requirements to apply:MD or DO from an accredited medical school.Board Certified in Internal Medicine or Family Practice.Fellowship training in geriatrics preferred.License to practice medicine in the State of Illinois.Must have or be eligible for...

  • Center Medical Director

    2 months ago

    Chicago, United States Cross Country Workforce Solutions Group Full time

    Join our Chicago, IL Team! Medical Director of PACE Salary Range $209,000 to $260,000 annually + benefits! Requirements to apply: MD or DO from an accredited medical school. Board Certified in Internal Medicine or Family Practice. Fellowship training in geriatrics preferred. License to practice medicine in the State of Illinois. Must have or be eligible...

  • Medical Director Physician

    2 days ago

    chicago, United States Pacific Companies Full time

    DocCafe has an immediate opening for the following position: Medical Director Physician in Chicago, Illinois. DocCafe is the premier physician and advanced practice job board to help you advance your healthcare career. Register now to apply for this job and for access to 125,000+ other openings. DocCafe Offers: Free Physician and Advanced Practice Job Search...

  • Executive Medical Director, Medical Affairs

    3 months ago

    Chicago, United States 001_BCBSA Blue Cross and Blue Shield Association Full time

    The Executive Director supports strategic and operational leadership of the BCBSA Clinical Team, including support of the creation of the clinical operations strategy and delivery of value-added resources and tools. This role provides clinical expertise and population health thought leadership in support of delivering more affordable and quality care for all...

  • Medical Director

    6 days ago

    Chicago, Illinois, United States Via Medica International Full time

    Job SummaryVia Medica International is seeking a highly skilled and experienced Medical Director to join our team. As a key member of our healthcare team, you will be responsible for providing medical guidance and support to our staff and patients.Key ResponsibilitiesHealth and Safety LeadershipCollaborate with our Health and Safety team to identify and...

  • Medical Director

    4 days ago

    Chicago, United States Careerbuilder-US Full time

    A national healthcare system expanding into Chicago with a new and innovated outpatient medical center is seeking to hire a full-time and permanent Medical Director - Physician to lead their team. This role is slated to start at the end of 2024 before the medical center opens in Q1 of 2025. If you have been seeking a more fulfilling, mission-driven...

  • Medical Director

    2 months ago

    Chicago, United States Careerbuilder-US Full time

    A national healthcare system expanding into Chicago with a new and innovated outpatient medical center is seeking to hire a full-time and permanent Medical Director - Physician to lead their team. This role is slated to start at the end of 2024 before the medical center opens in Q1 of 2025. If you have been seeking a more fulfilling,...

  • Site Medical Director

    4 weeks ago

    Chicago, United States Howard Brown Health Full time

    What you can expect:A Site Medical Director provides clinical and administrative leadership to Howard Brown Health Center and is responsible for the quality of care provided to participants in Primary Care at the assigned site, and for the clinical productivity of the medical provider clinical site staff.A Site Medical Director is a licensed professional...

  • Reise Physiotherapeut

    2 weeks ago

    Chicago, Illinois, United States All Medical Personnel Full time

    All Medical Personnel - Therapie sucht einen Reise Physiotherapeuten für eine temporäre Anstellung. Stellenbeschreibung & AnforderungenFachrichtung: PhysiotherapeutDisziplin: TherapieDauer: 13 Wochen40 Stunden pro WocheSchicht: 8 StundenAnstellungsart: ReiseSuchen Sie eine spannende Reise Physiotherapeut Stelle? All Medical Personnel - Therapie bietet eine...

  • Medical Director Complex Care

    7 days ago

    Chicago, United States AbsoluteCare Full time

    AbsoluteCare is seeking a dynamic physician leader to put the principles of population health into action for our medically complex & socially vulnerable members. Oftentimes, due to the effects of trauma and poverty, a significant portion of our population suffer from infectious diseases – including HIV, Hepatitis C, and complex wound infections. Through...

  • Group Medical Director, Pharmacovigilance

    3 months ago

    Chicago, Illinois, United States AbbVie Full time

    Company DescriptionAbbVie's mission is to discover and deliver innovative medicines and solutions that solve serious health issues today and address the medical challenges of tomorrow. We strive to have a remarkable impact on people's lives across several key therapeutic areas immunology, oncology, neuroscience, and eye care and products and services in our...

  • Medical Director – Transplant Cardiology

    2 months ago

    Chicago, Illinois, United States Northwestern University Feinberg School of Medicine Full time

    Medical Director – Transplant Cardiology (Clinician-Educator) The Division of Cardiology in the Department of Medicine at Northwestern University Feinberg School of Medicine seeks a full-time, non-tenure-eligible Clinician-Educator to serve as Medical Director, Transplant, in a nationally renowned cardiovascular institute and heart failure program....