Manager, Medical Director (US)

Anticipated End Date:

2026-02-20

Position Title:

Manager, Medical Director (US)

Job Description:

Manager Medical Director

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.

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.

The Manager Medical Director is responsible for the administration of medical services for company health plans including the overall medical policies of the business unit to ensure the appropriate and most cost-effective medical care is received and for the day-to-day management of medical management staff.

How will you make an impact:

• Interpret existing policies and develop new policies based on changes in the healthcare or medical arena.

• Lead, develop, direct and implement clinical and non-clinical activities that impact health care quality cost and outcomes.

• Identify and develop opportunities for innovation to increase effectiveness and quality.

• Serve as a resource and consultant to other areas of the company.

• May chair or serve on company committees.

• May be required to represent the company to external entities and/or serve on external committees.

• Conduct peer clinical and/or appeal case reviews along with peer-to-peer clinical reviews with attending physicians or other ordering providers.

• Discuss review determination, provide guidance for clinical operational aspects of the program.

• Support the medical management staff ensuring timely.

• Consistent responses to members and providers.

• Hires, trains, coaches, counsels, and evaluate performance of direct reports.

• Directly supervises the management of any assigned staff.

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. 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:

• Extensive experience in strategic and clinical oversight, specifically in the realm of grievance and appeals strongly preferred.

• Demonstrated proficiency in clinical case writing, with the ability to effectively articulate complex medical information and patient narratives in a clear and concise manner strongly preferred.

• Minimum of 2-5 years of experience in Medicaid and utilization management, with a proven track record of managing and optimizing healthcare resources effectively strongly preferred.

• Extensive experience working in managed care leadership strongly preferred.

• Strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills strongly preferred.

Job Level:

Director

Workshift:

1st Shift (United States of America)

Job Family:

MED > Licensed Physician/Doctor/Dentist

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.