Plan Performance Medical Director- Missouri Medicaid Market

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. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. 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 required 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, 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:

• 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.

Job Level: Director Equivalent

Workshift: 1st Shift (United States of America)

Job Family: MED > Licensed Physician/Doctor/Dentist

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.

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.

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 should submit the following form: Accessibility Accommodation Request Form and a member of the team will be in contact. 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.