Plan Performance Medical Director- Washington Medicaid

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Plan Performance Medical Director Washington Medicaid

Location: This role requires associates to be inoffice 3 days per week fostering collaboration and connectivity while providing flexibility to support productivity and worklife balance. This approach combines structured office engagement with the autonomy of virtual work promoting a dynamic and adaptable workplace. Alternate locations may be considered.

Work schedule: Monday Friday 8:00 am to 5:00 pm PST. Weekend rotation: once a month.

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 costeffective 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 .

The PPMD will oversee all physical Health Services provided to individuals. Will also be responsible for working with the CMO Behavioral Health CMO (BHCMO) Pharmaceutical director and the whole health director to ensure the integration of physical and Behavioral Health Services and supports.

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 peertopeer clinical reviews with attending physicians or other providers to discuss review determinations and patients office visits with providers and external physicians.

• May conduct peertopeer 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 nonclinical 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.

• 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.

• Washington resident preferred.

• Ability to obtain a Washington medical license after hire.

• Board certification in internal medicine family medicine or Emergency medicine is preferred.

For candidates working in person or virtually in the below location(s) the salary* range for this specific position is $262752 to $450432 .

Locations:California; Colorado; Nevada; Washington State

In addition to your salary Elevance Health offers benefits such as a comprehensive benefits package incentive and recognition programs equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate nondiscriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender race or any other category protected by federal state and local pay equity laws.

* The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location work experience education and/or skill level. Even within the range the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned vested and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus commission benefits or any other form of compensation and benefits that are allocable to a particular employee remains in the Companys sole discretion unless and until paid and may be modified at the Companys sole discretion consistent with the law.

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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 marketcompetitive 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.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/memberfacing roles to become vaccinated against COVID19 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 including but not limited to the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.