Director of Medical Services

Director of Medical Services Location: This role offers associates the flexibility to work virtually full-time, with required in-person training sessions providing essential onboarding and skill development. Alternative locations may be considered for candidates residing within a commuting distance from an office. Please note that candidates not within reasonable commuting distance from the posting locations will not be considered for employment unless an accommodation is required by law. Hours: Monday through Friday 8 am - 5 pm CST/EST. National Government Services is a proud member of Elevance Health's family of brands, fulfilling government contracts for Medicare and partnering with the Centers for Medicare and Medicaid Services to innovate federal health programs. The Director of Medical Services will oversee the administration of both physical and behavioral health medical services, ensuring that members receive the most appropriate and cost-effective medical care possible. This role may involve developing and implementing quality improvement programs, providing clinical consultation, and acting as a strategic advisor to enhance clinical operations. Additionally, the Director will identify opportunities to optimize care costs and may oversee entire clinical programs. How you will make an impact: Support clinicians in ensuring timely and consistent responses to members and providers. Provide guidance on the clinical operational aspects of programs. Act as a resource and consultant across various departments within the company. Represent the company to external entities and serve on internal and external committees as required. Chair company committees. Interpret medical policies and clinical guidelines. Develop and propose new medical policies to keep pace with healthcare changes. Lead, develop, direct, and implement clinical and non-clinical activities that significantly impact healthcare quality, cost, and outcomes. Identify and create opportunities for innovation to enhance effectiveness and quality. Minimum Requirements: MD/DO degree and Board certification by an appropriate certifying board (ABMS or AOA) is required. Active unrestricted medical license to practice medicine or a health profession. Must be located within the United States when conducting utilization reviews or appeals considerations. A minimum of 10 years of clinical experience or a combination of education and experience that provides an equivalent background. This position is part of the NGS division, which requires foreign national applicants to have resided in the US for at least three of the past five years. Preferred Skills, Capabilities, and Experiences: Excellent oral and written communication skills, problem-solving abilities, facilitation skills, and analytical thinking. Experience with MAC and Medicare Fee For Service is preferred. Experience in OBGYN, Primary Care, or Internal Medicine is preferred. If this job is assigned to any Government Business Division entity, additional requirements may apply, including more rigorous background checks and government clearances. Associates in these positions must adhere to specific policies and procedures as stated by the Government Business Division. Please be advised that Elevance Health only accepts resumes from agencies with a signed agreement. Unsolicited resumes will be considered property of Elevance Health. Who We Are Elevance Health is committed to improving lives and communities by making healthcare simpler. As a Fortune 25 company with a longstanding history in the industry, we seek passionate leaders at all levels devoted to making a positive impact on our members and communities. How We Work We cultivate a culture that fosters personal and professional growth, rooted in our values and behaviors. These guide us in achieving our strategic goals and driving success for our consumers, associates, communities, and business. We offer a competitive rewards package that includes merit increases, paid holidays, Paid Time Off, incentive bonuses, medical, dental, vision coverage, short and long-term disability benefits, a 401(k) with match, a stock purchase plan, wellness programs, and financial education resources, among other benefits. Elevance Health follows a Hybrid Workforce Strategy, requiring associates to work onsite at least once per week unless specified by the hiring manager. The health of our associates and communities is a top priority. All new candidates in patient/member-facing roles must be vaccinated against COVID-19 and Influenza, with exemptions considered as applicable. Elevance Health will comply with all relevant laws. Elevance Health is an Equal Employment Opportunity employer. All qualified applicants will receive consideration without regard to age, citizenship, color, creed, disability, ethnicity, genetic information, gender, marital status, national origin, race, religion, sex, sexual orientation, veteran status, or any other protected status under applicable laws. Applicants requiring accommodation during the application process may reach out for assistance. Qualified applicants with arrest or conviction records will be considered according to all applicable laws, including the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

Created: 2026-03-06