National Medical Director – Autism and Neurodevelopmental Disorders (Solution Medical Director)

Anticipated End Date:

2026-03-23

Position Title:

National Medical Director – Autism and Neurodevelopmental Disorders (Solution Medical Director)

Job Description:

National Medical Director – Autism and Neurodevelopmental Disorders (Solution Medical Director)

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.

The National Medical Director, Autism and Neurodevelopmental Disorders (Solution Medical Director) serves as the clinical subject matter expert (SME) and accountable clinical leader for programs supporting members diagnosed with Autism Spectrum Disorder and other neurodevelopmental conditions across Carelon Health solutions.

This role is responsible for setting clinical standards, ensuring the clinical integrity of program design and implementation, and advancing evidence-based approaches that improve access, quality, safety, and outcomes for members diagnosed with Autism Spectrum Disorder and related neurodevelopmental conditions.

The National Medical Director provides input into network strategy, drives data and outcomes, and develops and implements crisis-reduction and early intervention strategies to improve quality, consistency, and patient safety across the network. As a Solution Medical Director, this role partners across clinical operations, product teams, guideline development teams, and external stakeholders to ensure that clinical expertise is embedded end-to-end—from evidence review and guideline development through implementation in utilization management, care management, and whole-person care programs.

Responsible for leading the strategic implementation of programs designed to improve 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.

How you will make an impact:

• Partner with internal knowledge services and Guideline Research & Development teams to maintain and expand clinical guidelines that define medical necessity criteria based on current and accurate interpretation of medical literature and relevant specialty society recommendations.
• Inform and direct AI-enabled clinical decision support and automation tools to increase the accuracy, consistency, and efficiency of utilization management programs.
• Monitor competitor products and internal medical management capabilities and respond with recommendations for improvement in company models supporting members diagnosed with Autism Spectrum Disorder and other neurodevelopmental conditions.
• Contribute to development of Medical Management and Quality Management strategies designed to improve outcomes and access to appropriate services.
• Responsible for consistent adoption and implementation of all medical policies and clinical appropriateness criteria across programs.
• Provide clinical leadership for Utilization Management, Case Management, Disease Management, and Quality Management of National Accounts in cooperation with Regional Health Care Management (HCM) teams and the Chief Medical Officer.
• Provide clinical consultation on complex cases and support operational teams to ensure evidence-based guidelines are consistently applied and aligned with original program design.
• Provide clinical expertise in sales planning and participate in the acquisition and retention of internal and external clients.
• Collaborate with HCM leaders to refine and improve provider and medical management services to meet the needs of client stakeholders and improve outcomes for members diagnosed with Autism Spectrum Disorder and related neurodevelopmental conditions.
• Assure the clinical relevance of account reporting regarding the use of medical services by members.
• Communicate medical management trends and recommend company medical management responses to client stakeholders.
• Contribute to efforts to establish effective physician and facility quality and cost profiling and education.
• Contribute to improved provider relationships and engagement with national professional organizations and societies (e.g., APA, AMA, ACAP, CASP,