Utilization Management Medical Director

Utilization Management Medical Director Location: This role allows for full-time virtual work, with only mandatory in-person training sessions required, providing excellent flexibility and autonomy. This approach enhances productivity while supporting work-life balance and ensures essential face-to-face onboarding and skills development. Please note that candidates residing outside a reasonable commuting distance from the specified locations will not be considered unless an accommodation is required by law. Alternative locations may be taken into account. The Medical Director is tasked with reviewing cases for Medicaid members, overseeing the administration of physical health medical services, ensuring members receive appropriate and cost-effective medical care. The position may involve developing and implementing programs aimed at improving quality, cost, and patient outcomes, as well as providing clinical consultation and strategic guidance to enhance clinical operations. How you will make an impact: Support clinicians in providing timely and consistent responses to members and healthcare providers. Offer guidance on clinical operational aspects of programs. Conduct peer-to-peer clinical reviews with attending physicians or other providers to discuss review determinations and patients' office visits. Serve as a resource and consultant across various areas of the company. Represent the company to external entities and/or serve on both internal and external committees. Facilitate and/or chair company committees. Interpret medical policies and clinical guidelines. Develop and propose new medical policies reflecting changes in healthcare. Lead and implement clinical and non-clinical activities impacting healthcare quality, costs, and outcomes. Identify and foster opportunities for innovation to enhance effectiveness and quality. Minimum Requirements: MD or DO with Board certification from an approved certifying board, where applicable. Active unrestricted medical license to practice medicine is required. Must be located in a state or territory of the U.S. when performing utilization reviews or appeals considerations, excluding military bases or embassies. At least 10 years of clinical experience, or an equivalent combination of education and experience. If applicable, a minimum of 5 years of experience in healthcare for certain organizations. Additional experience may be mandated by state contracts or regulations. Preferred Qualifications: Specialties in Pediatrics, OB/GYN, Surgery, Emergency Medicine, Internal Medicine, or Family Medicine are preferred. 3-5 years of experience in Utilization Management is favored. An Indiana license or the ability to obtain one upon hiring is preferred. Please note that Elevance Health will only accept resumes from agencies with a signed agreement. Unsolicited resumes will be considered the property of Elevance Health. About Us Elevance Health is dedicated to improving lives and communities while simplifying healthcare. As a Fortune 25 company with a rich history in healthcare, we seek leaders who are passionate about making a difference for our members and the communities we serve. Our Work Culture At Elevance Health, we aim to foster a culture that not only advances our strategic goals but also promotes personal and professional growth for all associates. Our core values drive our culture, shaping our strategy, business outcomes, and collective success for our consumers, associates, communities, and our business. We provide a competitive total rewards package, including merit increases, paid holidays, Paid Time Off, incentive bonuses, and comprehensive benefits such as medical, dental, vision, short and long-term disability, 401(k) with a match, stock purchase plans, life insurance, wellness programs, and financial education resources. Elevance Health operates under a Hybrid Workforce Strategy. Unless specified as primarily virtual, associates are required to work onsite at an Elevance Health location at least once a week, with specifics discussed during the hiring process. The health and well-being of our associates and communities are paramount at Elevance Health. As such, we require new candidates in certain patient/member-facing roles to be vaccinated against COVID-19 and Influenza. Failure to be vaccinated without an acceptable explanation may result in the rescindment of your offer. Elevance Health will also comply with all relevant federal, state, and local laws. Elevance Health is an Equal Employment Opportunity employer. All qualified applicants will be considered for employment 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 status protected by applicable laws. Applicants requiring accommodation during the job application process may reach out for assistance. Qualified candidates with arrest or conviction records will be considered according to all applicable laws.

Created: 2026-03-10