Medical Director- Long Term Support Service (LTSS)

Anticipated End Date:

Position Title: Medical Director - Long Term Support Service (LTSS)

Overview

Position: Medical Director - Long Term Support Services. Preferred Location: Ohio. This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This hybrid/virtual work policy may limit consideration for candidates not within a reasonable commuting distance from the posting location, unless an accommodation is granted as required by law. MyCare Ohio Plan is to deliver high-quality, trauma-informed, culturally competent, person-centered coordination for all members that addresses physical health, behavioral health, long term services and supports, and psychosocial needs.

The Medical Director - Long Term Support Services is responsible for the administration of physical and/or behavioral health medical services, to ensure the appropriate and most cost-effective medical care is received. May be responsible for developing and implementing programs to improve quality, cost, and outcomes. May provide clinical consultation and serve as clinical/strategic advisor to enhance clinical operations. May identify cost of care opportunities. May serve as a resource to staff including Medical Director Associates. May be responsible for an entire clinical program.

Responsibilities

• Supports clinicians 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.
• Serves as a resource and consultant for other areas of the company.
• May be required to represent the company to external entities and/or serve on internal and/or external committees.
• May chair company committees.
• Interprets medical policies and clinical guidelines.
• May develop and propose new medical policies based on changes in healthcare.
• Leads, develops, directs, and implements clinical and non-clinical activities that impact health care quality, cost and outcomes.
• Identifies and develops opportunities for innovation to increase effectiveness and quality.
• Works independently with oversight from immediate manager.
• May be responsible for an entire clinical program and/or independently performs clinical reviews. The Medical Director typically has program management responsibilities including clinical policy development, program development/implementation, and overseeing clinical/non-clinical activities.

Minimum Requirements

• Requires MD or DO and Board certification approved by one of the following certifying boards: 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. Must be located in a state or territory of the United States when conducting utilization review or an appeals consideration, unless expressly allowed by state or federal law, and cannot be located on a US military base, vessel or any embassy located in or outside of the US.
• A minimum of 10 years of clinical experience; or any combination of education and experience that would provide an equivalent background.
• For Health Solutions and Carelon organizations (including behavioral health), a minimum of 5 years of health care experience is required.
• Additional experience may be required by State contracts or regulations if the Medical Director is filling a role required by a State agency.

Preferred Skills, Capabilities and Experiences

• 1-2 years Utilization Management experience strongly preferred.
• Strong oral, written, and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

Job Details

• Job Level: Director Equivalent
• Workshift: 1st Shift (United States of America)
• Job Family: MED > Licensed Physician/Doctor/Dentist

About Elevance Health / Equal Opportunity

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.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) with match, stock purchase plan, life insurance, wellness programs and financial education resources.

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.

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 for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws.