Plan Performance Medical Director- Arkansas Medicaid at Elevance Health in Little Rock, Arkansas

Job Description:

Plan Performance Medical Director- Arkansas Medicaid




Location: Alternate locations may be considered. This position will work a hybrid model (remote and office). Candidates must live within 50 miles of one of our Elevance Health office locations.




Work schedule: Monday - Friday, 8:00 am to 5:00 pm CST.



The Plan Performance Medical Director is responsible for serving as the lead clinician for a plan. Responsible for the administration of medical services for company health plan including the overall medical policies or clinical guidelines of the plan to ensure the most appropriate and cost-effective medical care is received. Drives direction of the plan related to cost of care and other plan directives. Works with the market plan president during meetings with State Regulators and other stakeholders.


Will oversee all primary and physical and Behavioral Health Services provided to individuals. Will also be responsible for working with the CMO, Behavioral Health CMO (BH-CMO), Pharmaceutical director and the behavior supports director to ensure the integration of physical and Behavioral Health Services.



How you will make an impact:

• Supports the Medical Management staff 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.
  
  


• Interprets existing policies or clinical guidelines and develops new policies based on changes in the healthcare or medical arena.
  
  


• Leads, develops, directs and implements clinical and non-clinical activities that impact efficient and effective care. Identifies and develops opportunities for innovation to increase effectiveness and quality.
  
  


• Provides expertise, captures and shares best practices across regions to other medical directors.
  
  


• May chair or serve on company committees, may be required to represent the company to external entities and/or serve on external committees.
  
  

Minimum Qualifications:

• 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).
  
  


• Requires active unrestricted medical license to practice medicine or a health profession in Arkansas.
  
  


• 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:

• At least five (5) years of experience in directing health care services for frail individuals of any age with physical, intellectual, and/or developmental disabilities is strongly preferred.
  
  


• Arkansas resident preferred.
  
  


• Board certification in psychiatry, internal medicine, family medicine, or pediatrics is preferred.
  
  

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 and Influenza. 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 elevancehealthjobssupport@elevancehealth.com for assistance.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act. Apply Now