National Medical Director - Total Cost of Care, Post Acute
Company: Elevance Health
Location: Denver
Posted on: May 18, 2024
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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.
Keywords: Elevance Health, Highlands Ranch , National Medical Director - Total Cost of Care, Post Acute, Executive , Denver, Colorado
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