Medicare Medical Director Clinical Programs

Elevance Health
US - Kentucky - Louisville
June 28, 2024
Medical

Wellpoint, formerly Amerigroup, is a proud member of Elevance Health s family of brands, offering Medicaid and Medicare plans in several states. We also provide administrative services to Medicaid plans in partnership with blue cross blue shield plans.This is an individual contributor role. This position will work a hybrid model (remote and office). The ideal candidate will live within 50 miles of one of our Elevance Health office locations Work schedule: 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. Collaborates with payment innovation on clinical programs that support providers in value-based payment arrangements. Serves as a subject matter expert/collaborator with LOB, leaders, and other clinical initiatives including cost of care. This role will work on Cost of Care, trend management, value-based care support for STARS/HEDIS and correct coding initiatives with providers as well as strategic growth and innovation initiatives.

How You Will Make An Impact

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.

Provides an end-to-end clinical solution by taking a problem from initiation to execution with reporting and analytics as an outcome.

Accountable for achieving performance results in value-based care by engaging, influencing and supporting physicians.

Engages with providers in joint operating committees and builds relationships with clinical leadership of provider collaboration groups.

Promotes clinical best practice sharing across all lines of business to improve results and drive efficiency and effectiveness.

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.

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 clinical experience; or any combination of education and experience, which would provide an equivalent background.

Preferred Skills, Capabilities And Experiences

Consulting experience and/or MBA.

Managed care experience improving cost of care trend.

Experience working with provider groups including practice managers, population health and quality directors on improving STARS/HEDIS or Risk Adjustment performance.

Six Sigma or formal process improvement experience preferred.

Analytical experience in creating study designs, ROIs and statistical techniques 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.

Travel up to 25% may be required depending on market needs.
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Associated topics: alumni, cmo, community, donor, government, market, medical center, policy, presale, stewardship

Read the full job description and apply online on the recuiter's web-site

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