Plan Performance Medical Director- Missouri Medicaid Market

Plan Performance Medical Director – Missouri Medicaid Market Location: Virtual full‑time with required in‑person meetings near St.Louis, MO. Must live within reasonable commuting distance to St.Louis. Responsibilities 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. Guides 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. Might chair or serve on company committees and represent the company to external entities and/or serve on external committees requiring in‑person meetings. Qualifications MD or DO with board certification from the American Board of Medical Specialties or American Osteopathic Association. Active, unrestricted medical license to practice in Missouri. Minimum 10 years of clinical experience, or equivalent combination of education and experience. Must be located in the United States when conducting utilization review or appeals consideration; cannot be located on a U.S. military base, vessel, or embassy. Preferred Skills, Capabilities, and Experiences Board certification in Internal Medicine, Family Medicine, Obstetrics, Pediatrics, or Emergency Medicine. Managed Care experience, specifically in Medicaid. Strong analytical abilities, including interpreting utilization and cost trends. Strong presentation and communication skills, especially for external stakeholder interactions. Job Level: Director. Workshift: 1st Shift (United States). Job Family: MED> Licensed Physician/Doctor/Dentist. EEO Statement: 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. #J-18808-Ljbffr