Plan Performance Medical Director (US)

Anticipated End Date:

2025-06-03

Position Title:

Plan Performance Medical Director (US)

Job Description:

Plan Performance Medical Director

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.

Hours: Monday - Friday 8 - 5 pm EST.

Federal Employee Program - FEP, a proud member of the Elevance Health, Inc. family of companies, it is a powerful combination, and the foundation upon which we are creating greater access to care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care.

The Plan Performance Medical Director is pivotal in ensuring the administration of effective and cost-efficient medical care. This role drives strategic direction regarding care costs and is responsible for advancing quality metrics, supporting comprehensive healthcare management, and leading clinical and non-clinical activities to enhance efficiency and effectiveness. The position also emphasizes innovation to improve overall healthcare quality and outcomes.

How you will make an Impact: 

• Collaborate with a team of quality professionals, including Quality Managers/Directors, HEDIS Analysts and staff, as well as clinical leaders of CM and DM, providers, and network partners, to align quality goals and drive performance improvement.

• Provides guidance for clinical operational aspects of a program.

• Implement evidence-based practices to enhance preventive care, chronic disease management, acute hospitalization prevention, and member engagement.

• Manage HEDIS data collection, reporting, and analysis.

• Drive initiatives to improve HEDIS scores, ensuring compliance with national benchmarks.

• 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.

• Oversee cost-management strategies and plan directives.

• Monitor and analyze key quality metrics, identify trends, and implement improvement strategies.

• Present findings and actionable strategies to executive leadership.

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).

• 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:

• Manage HEDIS data collection, reporting, and analysis to improve scores according to national benchmarks.

• Establish collaborative relationships with internal and external stakeholders to enhance patient care quality.

• Implement evidence-based practices for preventive care, chronic disease management, and member engagement.

• Maintain advanced knowledge of HEDIS, Medication Adherence, and Patient Experience measures.

• Lead teams of quality professionals, including Quality Managers/Directors and HEDIS Analysts.

• Collaborate with clinical leaders, providers, and network partners to align quality goals and drive performance improvements.

• Foster collaborative environments to influence system-wide changes.

• Design and implement clinical programs targeting specific medical conditions across all business lines.

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