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National Medical Director - Total Cost of Care, Post Acute

at Elevance Health in SOUTH PORTLAND, Maine, United States

Job Description

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 Solution Medical Director for a set of Post Acute Care Solutions. This high-performing individual contributor will be responsible for serving as a National Solution Medical Director for our Post Acute Solutions Clinical Product Line, overseeing clinical integrity for the service line, supporting the product strategy and design, and implementing medical management approaches that impact healthcare quality, cost, and outcomes. Additional responsibilities include executing on the product strategy, managing solution performance and improving access to and usefulness of health improvement tools offered to our health plan clients and members.

How you will make an impact:

+ Develops clinical appropriateness guidelines for post-acute solutions.

+ 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.

+ Provides thought leadership in laboratory medicine and genetic testing.

+ Communicates medical management trends and recommends company medical management responses to clients.

+ Contributes to efforts to establish effective provider quality and cost profiling and education.

+ Contributes to improved provider relationships and national associations and societies.

+ Represents the 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 certification is required. Requires experience with population or segment health management and the education and coaching of members on wellness, prevention, and healthy lifestyles.

Strongly Preferred:

+ Certified with the American Board of Physical Medicine & Rehabilitation or Geriatrics and 12+ years of experience preferred.

+ MBA and/or experience in Administrative Medicine, Business Strategy, Product Strategy.

+ Experience with managing risk programs, ACO’s, IPAs, at risk health systems. Population health management and whole person-end to end risk management.

+ Benefits Management decision support experience in the Post-Acute Domain, DME, Home Health, and Wound Care.

+ Experience with Clinical guideline research and development, medical necessity, and medical policy.

+ Ability to travel ~10%.

For candidates working in person or remotely in the below locations, the salary* range for this specific position is $249,680 to $449,424

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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Job Posting: JC260001962

Posted On: May 17, 2024

Updated On: Jun 12, 2024

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