Plan Performance Medical Director- Missouri Medicaid Market

Plan Performance Medical Director- Missouri Medicaid Market Location: This role enables associates to work virtually full‑time, with the exception of required in‑person meetings, providing maximum flexibility and autonomy. This approach promotes productivity, supports work‑life integration, and ensures essential face‑to‑face collaboration. Candidates must live near the St. Louis location. The Plan Performance Medical Director (PPMD) is a trusted clinical partner for the MO Medicaid market. The PPMD will oversee clinical program operations within the health plan. The individual will collaborate closely with executive leadership, including the plan president and nursing leadership, to ensure smooth daily operations. Responsibilities also include monitoring performance trends, addressing cost and quality metrics, supporting compliance with state requirements, and contributing to utilization management efforts when necessary. How you will make an impact Leads, develops, directs and implements clinical and non‑clinical activities that impact efficient and effective care Supports new and existing customers by delivering clinical insights and recommendations that enhance the value‑proposition of clinical programs Identifies and develops opportunities for innovation to increase effectiveness and quality Provides expertise; captures and shares best practices across regions Provides guidance for clinical operational aspects of a program Interprets existing policies or clinical guidelines and supports new policies based on changes in the healthcare or medical arena Conducts peer‑to‑peer clinical reviews with attending physicians or other providers to discuss review determinations. May chair or serve on company committees, may be required to represent the company to external entities and/or serve on external committees which will require in‑person meetings. 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 in Missouri. Unless expressly allowed by state or federal law, 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 Board certification in Internal Medicine, Family Medicine, Obstetrics, Pediatrics, or Emergency Medicine preferred. Managed Care experience, specifically in Medicaid preferred. Strong analytical abilities, including interpreting utilization and cost trends preferred. Strong presentation and communication skills, especially for external stakeholder interactions 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. 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 View email address on click.appcast.io 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. Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration. #J-18808-Ljbffr Elevance Health