Plan Performance Medical Director- Washington Medicaid

Anticipated End Date:

2025-06-06

Position Title:

Plan Performance Medical Director- Washington Medicaid

Job Description:

Plan Performance Medical Director- Washington Medicaid

Location: This role requires associates to be in-office 3 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life 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 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 .

The PPMD will oversee all physical Health Services provided to individuals. Will also be responsible for working with the CMO, Behavioral Health CMO (BH-CMO), 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 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.

• 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 $262,752 to $450,432 .

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, 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