Behavioral Health Medical Director - Psychiatrist- Pennsylvania Medicaid

Behavioral Health Medical Director - Psychiatrist- Pennsylvania Medicaid Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. Candidates not within a reasonable commuting distance from the posting location(s) will not be considered unless an accommodation is granted as required by law. Ideal candidates will live in Pennsylvania. Alternate locations may be considered. The Behavioral Health Medical Director is responsible for the administrative oversight of behavioral health medical services, ensuring the appropriate and most cost‑effective medical care is received. They may develop and implement programs to improve quality, cost, and outcomes, provide clinical consultation and serve as a clinical/strategic advisor, identify cost of care opportunities, serve as a resource to staff including Medical Director Associates, and be responsible for an entire clinical program. How you will make an impact: Supports clinicians to ensure timely and consistent responses to members and providers. Provides guidance for clinical operational aspects of a program. Conducts peer‑to‑peer clinical reviews with attending physicians or other providers to discuss review determinations and patients’ office visits with providers and external physicians. May conduct peer‑to‑peer clinical appeal case reviews with attending physicians or other ordering providers to discuss review determinations. Serves as a resource and consultant for other areas of the company. May be required to represent the company to external entities and/or serve on internal and/or external committees. May chair company committees. Interprets medical policies and clinical guidelines. May develop and propose new medical policies based on changes in healthcare. Leads, develops, directs, and implements clinical and non‑clinical activities that impact health care quality, cost and outcomes. Identifies and develops opportunities for innovation to increase effectiveness and quality. Minimum Requirements: Requires MD or DO and Board certification approved by the American Board of Medical Specialties (ABMS) or American Osteopathic Association (AOA) where applicable. Must possess an active unrestricted medical license to practice medicine or a health profession. 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 an equivalent combination of education and experience. For Health Solutions and Carelon organizations (including behavioral health) only, minimum of 5 years of experience providing health care is required. Additional experience may be required by State contracts or regulations if the Medical Director is filing a role required by a State agency. Preferred Qualifications: Ability to obtain a Pennsylvania medical license upon hire. Utilization and clinical management experience preferred. Experience working with Medicaid populations preferred. 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 state or federal protected class. 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