Job Information
Elevance Health Medical Director Clin Programs (US) in Cincinnati, Ohio
Medical Director of Clinical Programs
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.
Location: This is a Hybrid position and preferred candidates must reside within 50 miles of an Elevance Health PulsePoint location.
Hours: Monday through Friday 8 am - 5 pm MST, PST or CST.
The Medical Director of Clinical Programs is responsible for the administration of appropriate and most cost-effective medical care. Drives the direction of the plan related to the improvement of HEDIS and STARS. Monitor and report on key quality metrics, identifying trends and areas for improvement. Supports the Comprehensive Healthcare Management staff to ensure timely and consistent responses to members and providers. 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.
How you will make an Impact:
Designs and develops national-level interventions leveraging existing tools that will drive performance in value-based care in support of the innovation and execution of corporate clinical interventions.
Provides clinical expertise and captures and shares best practices across regions to provider partners as well as the company’s medical directors by way of studying designs, analytics, and reporting for clinical quality that drives improved healthcare outcomes.
Provides an end-to-end clinical solution by taking a problem from initiation to execution with reporting and analytics as an outcome.
Accountable for achieving performance results in value-based care by engaging, influencing, and supporting physicians.
Engages with providers in joint operating committees and builds relationships with clinical leadership of provider collaboration groups.
Promotes clinical best practice sharing across all lines of business to improve results and drive efficiency and effectiveness.
Works to develop and deliver high-impact interventions, supporting content development and practice transformation-embedded capabilities to significantly improve provider performance that drive cost of care and improve HEDIS/Stars where applicable.
Manage HEDIS data collection, reporting, and analysis. Drive initiatives to improve HEDIS scores, ensuring compliance with national benchmarks.
Create collaborative working relationships across the organization and network of providers to advance the quality of care for our patients and improve.
Implement evidence-based practices to enhance preventive care, chronic disease management, acute hospitalization prevention, and member engagement.
Maintains up-to-date advanced knowledge of HEDIS, Medication Adherence, and Patient experience measures.
Minimum Requirements:
Requires MD or DO. Also requires BA/BS in health-related field and minimum of 10 years of experience; or any combination of education and experience, which would provide an equivalent background.
Current unrestricted medical license in applicable state(s) required.
Board certification in a medical specialty is required.
Preferred Skills, Capabilities, and Experiences:
Advanced knowledge in health care systems and health policy, quality measures, performance measurement, and quality improvement, and the clinical understanding for clinical quality programs strongly preferred.
Six Sigma or formal process improvement experience preferred. Analytical experience in creating study designs, ROIs and statistical techniques preferred.
Experience collaborating with a team of quality professionals, including Quality Managers/Directors and HEDIS Analysts and staff, is preferred.
Experience collaborating with clinical leaders of CM and DM, providers, and network partners to align quality goals and drive performance improvement is preferred..
Experienced monitoring and reporting on key quality metrics, identifying trends and areas for improvement is preferred.
Experience presenting findings to executive leadership and recommending actionable strategies is preferred.
10+ years of experience in quality management, quality improvement, or healthcare operations is preferred.
4+ years’ experience in leading high-performing teams and managing people is preferred.
Must have a firm understanding of STARS, HEDIS, and CAHPS, and performance improvement is preferred.
Must have excellent collaboration and communications skills and can influence system change across teams is preferred.
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. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.
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 elevancehealthjobssupport@elevancehealth.com 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.