Plan Medical Director

Plan Performance Medical Director – Elevance Health

Base pay range: $/yr - $/yr

Location:

Virtual full‑time with required in‑person training sessions; alternate locations may be considered. 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.

The Plan Performance Medical Director serves as a lead clinician overseeing the administration of medical services for individual ACA health plans across 17 states. Responsibilities include managing overall medical policies, guiding clinical operations, conducting peer‑to‑peer clinical reviews, developing policies, driving cost‑effectiveness, and collaborating with market plan presidents during state regulator meetings.

• Supports the Medical Management staff 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.
• May conduct peer‑to‑peer clinical appeal case reviews with attending physicians.
• Interprets existing policies or clinical guidelines and develops new policies based on changes in the healthcare or medical arena.
• Leads, develops, directs and implements clinical and non‑clinical activities that impact efficient and effective care.
• Identifies and develops opportunities for innovation to increase effectiveness and quality.
• Provides expertise, captures and shares best practices across regions to other medical directors.
• May chair or serve on company committees, and may represent the company to external entities or serve on external committees.

• MD or DO with board certification approved by ABMS or AOA.
• Active unrestricted medical license to practice medicine or a health profession; must be located in a U.S. state or territory when conducting utilization review or appeals (unless otherwise allowed by law).
• Minimum of 10 years of clinical experience, or an equivalent combination of education and experience.
• Strong oral, written, and interpersonal communication skills; problem‑solving, facilitation, and analytical skills.
• Ability to travel to worksite and other locations as necessary.
• Understanding of and compliance with Government Business Division policies if applicable.

• Experience with clinical finance data, medical cost and trend analysis.
• Strong communication skills, including presentation and writing.
• Proficiency in Excel and PowerPoint.

Benefits include a comprehensive benefits package, incentive and recognition programs, equity stock purchase, and 401(k) contribution. Salary is based on skills and experience;
Elevance Health is committed to ensuring equal pay opportunities for all protected categories.

Equal Employment Opportunity 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.

Applicants who require accommodation to participate in the job application process may contact elevancehealthj for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.