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Medical Director (US) - Idaho

Company: Elevance Health
Location: Meridian
Posted on: September 23, 2022

Job Description:

Medical Director (US) - Idaho

  • Job Family: Medical and Clinical
  • Type: Full time
  • Date Posted:Sep 12, 2022
  • Req #: JR16332Location:
    • ID, MeridianDescriptionJoin the newly created partnership to be the next Managed Care Organization for the Idaho Department of Health and Welfare! The Idaho Behavioral Health Collaborative recognizes that health care is local. The Collaborative combines national expertise with local knowledge. Beacon Health Options, a member of the Elevance Health family of companies, brings the strength, expertise and best practices of a leading national behavioral health leader. Our local partners, include Blue Cross Idaho (BCI), BPA Health, and the Idaho Crisis & Suicide Hotline (ICSH) complete that expertise with trusted relationships, local decision-making and flexibility. The four organizations have a combined 154 years of expertise, with almost 120 in in the state of Idaho, serving individuals with behavioral health conditions ranging from mild-to-moderate to chronic and complex.
      • Beacon Health Options brings the strength, expertise and best practices of one of the nations leading behavioral health service organizations
      • Blue Cross of Idaho has strong relationships with behavioral health providers coupled with its strong community presence and local grassroots partnerships throughout Idaho
      • BPA Health , Idahos leading behavioral health administrator, completes that expertise with trusted relationships, local decision-making and flexibility.
      • Idaho Suicide Prevention Hotline provides 24/7, free and confidential support for people in distress, as well as prevention and crisis resources for residents of Idaho.This position will serve as a key leader of the Idaho Behavioral Health Collaborative, based in Boise, Idaho. Notice of contract award is expected in October 2022. In anticipation of that award, we are recruiting top talent in effort to have contingency hires offered with starting dates in late October 2022.The Medical Director is responsible for the administration of behavioral health medical services for the Idaho Behavioral Health Collaborative, to ensure the appropriate and most cost effective medical care is received. Leads the development and implementation of programs to improve quality, cost, and outcomes. Provides clinical consultation and serves as clinical/strategic advisor to enhance clinical operations. Identifies cost of care opportunities. Serves as a resource to clinical staff including any Medical Director Associates of physician peer reviewers. May be responsible for an entire clinical program. The Medical Director typically has program management responsibilities including clinical policy development, program development/implementation, and overseeing clinical/non-clinical activities.Primary duties may include, but are not limited to:
        • 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.
        • 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 to 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 local or national 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.
        • Works independently with oversight from immediate manager.
        • May be responsible for an entire clinical program and/or independently performs clinical reviews.Position requirements:
          • Requires MD or DO and Board certification in Psychiatry approved by one of the following certifying boards, American Board of Medical Specialties (ABMS) or American Osteopathic Association (AOA).
          • Must possess (or be willing to obtain) an active unrestricted medical license to practice medicine in the State of Idaho.
          • 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 5 years of experience providing behavioral 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.
          • Must be located in Idaho.For URAC accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills. If this job is assigned to any Government Business Division entity, the applicant and incumbent fall under a `sensitive position' work designation and may be subject to additional requirements beyond those associates outside Government Business Divisions. Requirements include but are not limited to more stringent and frequent background checks and/or government clearances, segregation of duties principles, role specific training, monitoring of daily job functions, and sensitive data handling instructions. Associates in these jobs must follow the specific policies, procedures, guidelines, etc. as stated by the Government Business Division in which they are employed.Please be advised that Elevance Health only accepts resumes from agencies that have a signed agreement with Elevance Health. Accordingly, Elevance Health is not obligated to pay referral fees to any agency that is not a party to an agreement with Elevance Health. Thus, any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.Be part of an Extraordinary TeamElevance Health is a health company dedicated to improving lives and communities and making healthcare simpler. Previously known as Anthem, Inc., we have evolved into a company focused on whole health and updated our name to better reflect the direction the company is heading.We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?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.The health of our associates and communities is a top priority for Elevance Health. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide and Elevance Health approves a valid religious or medical explanation as to why you are not able to get vaccinated that Elevance Health is able to reasonably accommodate. Elevance Health will also follow all relevant federal, state and local laws.Elevance Health has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 Worlds Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at 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 for assistance.EEO is the LawEqual Opportunity Employer / Disability / VeteranPlease use the links below to review statements of protection from discrimination under Federal law for job applicants and employees.
            • EEO Policy Statement
            • EEO is the Law Poster
            • EEO Poster Supplement-English Version
            • Pay Transparency
            • Privacy Notice for California ResidentsElevance Health, Inc. is an E-verify EmployerNeed Assistance?Email us ( or call 1-877-204-7664

Keywords: Elevance Health, Meridian , Medical Director (US) - Idaho, Executive , Meridian, Idaho

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