National Medical Director for Advancing Imaging Services- Carelon

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National Medical Director for Advancing Imaging Services- Carelon

Location: This role enables associates to work virtually full-time with the exception of required in-person training sessions providing maximum flexibility and autonomy. This approach promotes productivity supports work-life integration and ensures essential face-to-face onboarding and skill development. Please note that per our policy on hybrid/virtual work candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment unless an accommodation is granted as required by law. Alternate locations may be considered.

Responsible for serving as a National Medical Director of the Advancing Imaging solution leading the strategic implementation of improving the health of the people we serve influencing product strategy and design and medical management approaches that impact health care quality cost and outcomes and improving access to and usefulness of health improvement by identifying defining and operationalizing evidence-based clinical appropriateness criteria for radiology services

How you will make an impact:

• Partner with internal knowledge services team to maintain and expand clinical guidelines that define medical necessity criteria for advanced imaging services based on current and accurate interpretation of medical literature and relevant society recommendations.

• Inform and direct AI tool development to increase accuracy and efficiency of utilization management programs

• Monitors competitor products and internal medical management capabilities and responds with recommendations for improvement in company models.

• Contributes to development of Medical Management and Quality Management strategies. Responsible for consistent adoption and implementation of all medical policies.

• Provides clinical leadership for Utilization Management Case Management Disease Management and Quality Management of National Accounts in cooperation with Regional Health Care Management (HCM) team and Chief Medical Officer.

• Provides clinical expertise in sales planning and participates in the acquisition and retention of internal and external clients.

• Collaborates with HCM leaders to refine and improve provider and medical management services to meet the needs of the client stakeholders.

• Assures the clinical relevance of account reporting regarding use of medical services by members.

• Communicates medical management trends and recommends company medical management responses to the client stakeholders.

• Contributes to efforts to establish effective physician and hospital quality and cost profiling and education.

• Contributes to improved provider relationships and national associations and societies (i.e. AMA Coalition of Specialty Societies).

• Represents company at nationally recognized speaking engagements to promote health programs.

Minimum Requirements:

• Requires MD or DO and minimum of 12 years of healthcare experience; or any combination of education and experience which would provide an equivalent background.

• Requires current unrestricted medical licensure in applicable state(s).

• Board certification required if applicable to the duties being performed.

• Requires experience with population or segment health management and the education and coaching of members on wellness prevention and healthy lifestyles.

Preferred Qualifications:

• Board certification in radiology or a radiologic subspecialty is strongly preferred.

• Knowledge of leading competitive product offerings in the healthcare industry and marketplace standards and managed care knowledge strongly preferred.

• Experience working with AI tool development preferred.

For candidates working in person or virtually in the below locations the salary* range for this specific position is $260080.00 to $468144.00.

Location(s): Washington DC Illinois Maryland Massachusetts New Jersey New York Columbus OH.

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 non-discriminatory 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 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 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.

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 including but not limited to the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.