Medicare Medical Director Clinical Programs

Job Description

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 a remote, individual contributor role and the person in this position must live within 50 miles of an Elevance Health location.

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.

Job Level : Director Equivalent

Director Equivalent

Workshift :

1st Shift (United States of America)

Job Family : MED >

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.