Medical Director - Medicare Fee for Service

Position Overview Medical Director – Medicare Fee for Service Full‑time, virtual (requires in‑person training sessions and occasional visits). Hours: Monday‑Friday 8am‑5pm CST/EST. Responsibilities Administer physical and/or behavioral health medical services to ensure cost‑effective, high‑quality care. Develop and implement programs that improve quality, reduce cost and enhance outcomes. Provide clinical consultation and serve as clinical/strategic advisor to enhance operations. Identify opportunities to reduce cost of care. Serve as resource for staff, including Medical Director Associates. Oversee an entire clinical program. Support clinicians to deliver timely, consistent responses to members and providers. Offer guidance on clinical operational aspects of a program. Act as a consultant to other company areas. Represent the company to external entities and serve on internal or external committees. Chair company committees as required. Interpret medical policies and clinical guidelines. Develop and propose new medical policies based on changing healthcare landscape. Lead, develop, direct, and implement clinical and non‑clinical activities impacting health‑care quality, cost and outcomes. Identify and develop innovation opportunities to increase effectiveness and quality. Minimum Requirements MD or DO with board certification from the American Board of Medical Specialties (ABMS) or the American Osteopathic Association (AOA). Active unrestricted medical license to practice medicine or a health profession. Must be located in the United States for utilization review or appeal duties (not on a US military base, vessel, or embassy). Minimum of 10 years of clinical experience or an equivalent combination of education and experience. Foreign nationals must have resided in the United States for at least three of the past five years. Preferred Skills, Capabilities, and Experiences Strong oral, written, interpersonal, problem‑solving, facilitation, and analytical skills. Experience in Medicare Administrative Contractor (MAC) operations. Experience in Medicare Fee‑for‑Service programs. Board certification in internal medicine, family medicine, hospice/palliative care, or geriatrics. Experience in a government business division (enhanced background checks, clearances, and other security protocols may apply). Benefits Competitive total rewards package including merit increases, paid holidays, paid time off, incentive bonus programs, medical, dental, vision, short‑ and long‑term disability, 401(k) with match, stock purchase plan, life insurance, wellness programs, and financial education resources. Equal Employment Opportunity Elevance Health is an Equal Employment Opportunity employer. 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. #J-18808-Ljbffr National Government Services