Medical Director- Long Term Support and Service (LTSS)

Job Description:

The Medical Director -Long Term Support and 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.

Responsibilities:

• Oversee all primary and physical health services provided to individuals of the health plan, including those receiving LTSS, ensuring the appropriate level of medical care is received.
• Ensure services align with LTSS clinical and service coordination requirements as defined by state and federal contracts/rules.
• Conduct targeted LTSS Case Management training sessions, emphasizing the most prevalent medical diagnoses affecting the key LTSS populations.
• Assist with resource development and drive Health Plan collaborations to support LTSS/HCBS populations.
• 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.

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.
• A 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:

• Minimum of ten years of clinical experience, including at least five years of experience directing healthcare services for target populations strongly preferred.
• 1-2 years Utilization Management experience strongly preferred.
• Strong oral, written, and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

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.