Medical Management Director jobs in Pennsylvania

Medical Management Director directs and oversees the operations and strategic planning of the organization's medical management initiatives and programs. Establishes case management, utilization review, quality and outcome management, and community education programs to provide high quality, cost effective health care services. Being a Medical Management Director develops and implements clinical guidelines for care designed to improve outcomes while managing costs. Requires a bachelor's degree. Additionally, Medical Management Director typically reports to top management. The Medical Management Director typically manages through subordinate managers and professionals in larger groups of moderate complexity. Provides input to strategic decisions that affect the functional area of responsibility. May give input into developing the budget. Capable of resolving escalated issues arising from operations and requiring coordination with other departments. To be a Medical Management Director typically requires 3+ years of managerial experience. (Copyright 2024 Salary.com)

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Utilization Management Medical Director
  • Elevance Health
  • Indiana, PA FULL_TIME
  • Description

    This is a remote individual contributor role and the person in this position must live within 50 miles of an Elevance Health location. Work schedule: Monday - Friday, 8:00 am to 5:00 pm EST.

    The Medical Director is responsible for the administration of physical and/or behavioral health medical services, to ensure the appropriate and most cost effective medical care is received. May be responsible for developing and implementing programs to improve quality, cost, and outcomes. May provide clinical consultation and serve as clinical/strategic advisor to enhance clinical operations. May identify cost of care opportunities. May serve as a resource to staff including Medical Director Associates. May be responsible for an entire clinical program.

    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, 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 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 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.  {Note: The following are level distinctions not required for posting. This level may provide oversight, direction, and guidance to Medical Director Associates. Works independently with oversight from immediate manager.
    • May be responsible for an entire clinical program and/or independently performs clinical reviews.
    • The Medical Director typically has program management responsibilities including clinical policy development, program development/implementation, and overseeing clinical/non-clinical activities.}

    Minimum Requirements:

    • 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).
    • 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 any combination of education and experience, which would provide an equivalent background. 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.

    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 for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

    Who We Are

    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.

    How We Work

    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. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.

    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. 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 may contact elevancehealthjobssupport@elevancehealth.comfor assistance.

  • 15 Days Ago

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Psychiatric Medical Director, Philly
  • Food Management Search
  • Philadelphia, PA FULL_TIME
  • Psychiatric Medical Director / Days, Philly- Our Clients mission is to provide health and human services that empower individuals, families and communities to live healthier, self-determined lives. Th...
  • 23 Days Ago

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Emergency Medicine, Medical Director (MD or DO)
  • Food Management Search
  • Wellsboro, PA FULL_TIME
  • Emergency Medicine, Medical Director (MD / DO) Wellsboro, PA We are seeking an experienced Medical Director (MD/DO) for a long term / permanent (1099) role in Wellsboro, PA. Highlights: Leadership rol...
  • 20 Days Ago

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Research Analyst - Medical Management Performance
  • Medical Management Performance - Independence Blue Cross Careers
  • Philadelphia, PA FULL_TIME
  • Bring your drive for excellence, teamwork, and customer commitment to Independence. Join us as we renew and reimagine the future of health care. Together we will achieve our mission to enhance the hea...
  • 25 Days Ago

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Director of Risk Management
  • AION Management LLC
  • Philadelphia, PA FULL_TIME
  • Director of Risk Management AION Management is part of a group of companies that represent all areas of real estate. AION’s companies – AION Partners, AION Management, and AION Construction – are comm...
  • Just Posted

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Regional Director of Property Management
  • Odin Management LLC
  • Philadelphia, PA FULL_TIME
  • DescriptionProfessionally owned and managed property management and development company is seeking a Regional Director of Property Management to join the Team and oversee ~4,000 units. The position wi...
  • 3 Days Ago

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Managing Director
  • SpartaCraft
  • Connelly Springs, NC
  • Job Description Job Description SpartaCraft, a contract wood products and finishing company in Connelly Springs, NC is l...
  • 3/28/2024 12:00:00 AM

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Managing Director
  • Chapman Associates, Inc.
  • Chapman Associates is a Mergers & Acquisitions association focused on middle-market strategic acquisitions on the buy an...
  • 3/28/2024 12:00:00 AM

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Case Management Director
  • Clinical Management Consultants
  • Plainview, TX
  • An award winning medical center is searching for a strong, experienced Case Management Director. Our team is excited to ...
  • 3/25/2024 12:00:00 AM

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Managing Director / Senior Managing Director - Debt Advisory
  • Oberon Securities, LLC
  • New York, NY
  • Oberon Securities, based in New York City, is seeking experienced Managing Directors with expertise raising asset, cash ...
  • 3/25/2024 12:00:00 AM

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Managing Director Relationship Manager-MMB
  • First Citizens Bank
  • Santa Monica, CA
  • Overview: First Citizens Middle Market Banking delivers a range of financial solutions to midsize clients through a rela...
  • 3/25/2024 12:00:00 AM

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Managing Director
  • Transamerica Premier Life Insurance Company
  • Nashville, TN
  • The Managing Director is responsible for growing the business of the District Office by developing new quality sales, co...
  • 3/25/2024 12:00:00 AM

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Managing Director
  • Artech L.L.C.
  • Fremont, CA
  • Artech is currently looking to hire an experienced Managing Director to join our expanding team in Fremont, CA (Hybrid)....
  • 3/25/2024 12:00:00 AM

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Managing Director
  • Selby Jennings
  • Chicago, IL
  • Join a dynamic and growing team at our Client; A premier financial services firm specializing in middle-market transacti...
  • 3/24/2024 12:00:00 AM

Pennsylvania (/ˌpɛnsɪlˈveɪniə/ (listen) PEN-sil-VAY-nee-ə), officially the Commonwealth of Pennsylvania, is a state located in the northeastern and Mid-Atlantic regions of the United States. The Appalachian Mountains run through its middle. The Commonwealth is bordered by Delaware to the southeast, Maryland to the south, West Virginia to the southwest, Ohio to the west, Lake Erie and the Canadian province of Ontario to the northwest, New York to the north, and New Jersey to the east. Pennsylvania is the 33rd-largest state by area, and the 6th-most populous state according to the most recent of...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Medical Management Director jobs
$153,144 to $205,085

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