Medical Director jobs at TMAC - 367 jobs

Prior Authorization Medical Director Physician Opportunity in the Los Angeles Area Please consider this unique opportunity to join a well-established and respected group of innovators in value-based care. This group of thought-leaders are in search of physician leaders to work alongside them to move the organization forward. Requirements MD/DO degree required Remote position, but candidate must live in the greater L.A. area for onsite meetings. Minimum of five years of prior clinical experience required, with at least two years of managed-care or health-plan experience preferred About the Opportunity Understand, promote, and manage the principles of medical management to facilitate the right care for patients at the right time and in the right setting. Review prior authorization requests for medical necessity using appropriate clinical guidelines. Identify high-risk patients and help coordinate care with the Employer's high-risk team. Participate in meetings to review, develop, and continually improve internal quality improvement and peer review processes and programs. Perform prior authorization functions for various Employer campuses, should the need arise in cross coverage, secondary/tertiary review, or medical director decision-making. Perform retroactive claims review for outpatient and inpatient care, as needed. Compensation and Benefits Competitive salary and aggressive incentives Comprehensive benefits including medical, dental, vision, and 401k Sign on bonus Ample paid time off About the Area Live in the entertainment capital of he world and enjoy dynamic mix of amenities that include outdoor adventures, fine dining, theme parks, the arts, world-class sports teams, and access to a major international airport Unmatched cultural amenities in one of the most diverse areas of the world Excellent public and private schooling options as highly respected colleges and universities World-class beaches and mountain resorts are within a short drive Enjoy a warm climate with over 300 sunny days a year

An Urgent Care Medical Director position is available in Atlanta, Georgia that involves overseeing and working at six different sites in the northern part of the city. Opportunity Details 95% Clinical Help train new physicians 12-hour shifts, usually doing 10-14 per month Compensation/Benefits Hourly rate plus p atient satisfaction bonus Profit sharing Full benefits include 401K, 100% total family health, dental, and vision About Atlanta, Georgia Atlanta is a vibrant city known for its world-class restaurants, lively nightlife, professional sports, and numerous attractions and events. It is considered the entertainment hub of the South. Atlanta's creative and dynamic atmosphere has made it a popular destination, with National Geographic named one of the top places to visit in their Best of the World 2022 list. GJ-9

A leading destination management company in San Diego is searching for a Director of Sales to drive growth across California and the West Coast. The ideal candidate will possess over 10 years of experience in DMC or hospitality, with at least 3 years in sales leadership. Responsibilities include mentoring a sales team, building key industry relationships, and using Salesforce for pipeline management. The role offers a competitive compensation package, flexible working conditions, and a focus on professional development. #J-18808-Ljbffr

Orrick currently has an excellent opportunity on our Financial Services Litigation team for a Senior Manager, Practice Information & Communication, based in our New York or San Francisco office. In this role, you will use your understanding of complex litigation and financial services/private funds ecosystem to help one of the firm's leading practices accelerate its growth. This role presents an opportunity to deploy your strong written advocacy, project management, and analytical skills to make a business impact. Be part of a diverse team of recognized leaders in their field, with a strong passion for delivering the best for our clients and competing at the highest level. Responsibilities Carefully monitor the group's matters to identify opportunities to promote results for its first chairs and team. Optimize opportunities for collaboration. Collaborate with media relations resources (internal and external) to ensure optimal media and social media coverage of our results and our team, including AmLaw Litigators of the Week recognition. Support partners in sharing content via LinkedIn. Maintain a current database of coverage to leverage for marketing collateral. Draft and maintain all marketing collateral, including partner bios - ensuring they are up to date on our story, our results and feature media coverage. Draft and maintain website content about the practice. Develop and execute a thought leadership plan, publishing the minimum effective amount to support SEO and GEO results and give partners occasional opportunities to reach out to interested clients. Support the directory submission process, ensuring we submit our best results for all appropriate rankings and taking a strategic approach to advocating for the most important upward moves. Collaborate with the communications team to submit the group and its partners for media-driven awards. Collaborate with the events team to execute on all aspects of client entertainment and events in which the group participates. Develop content to share internally as appropriate to promote collaboration. Develop a plan of action and drive weekly meetings with the Chief Practice Officer and/or Practice Leader to refresh priorities and discuss progress. The role will collaborate with the firm's Communications, Events, Business Development, Talent, Research and Practice Management teams and all of the firm's other resources to deliver all of the above in a way that is tailored to the needs of the team and the clients and markets it serves. Qualifications Bachelor's degree or equivalent experience. 8+ years of experience in business development, marketing, or communications within legal, financial services, or private funds sectors. Strong understanding of complex litigation and the financial services/private funds ecosystem. Excellent written and verbal communication skills, with experience drafting marketing materials, thought leadership, and digital content. Ability to analyze matters and identify business development opportunities to promote results, optimize collaboration, and support business growth. Proven project management abilities, including managing multiple priorities and stakeholders. Demonstrated success in building collaborative relationships across teams and with firm leadership. Experience with media relations, event planning, and supporting directory submissions and awards. Client-focused approach with a commitment to delivering results. Proficiency with social media (especially LinkedIn) and familiarity with SEO and digital marketing. High level of professionalism, discretion, and adaptability in a fast-paced environment. Who is Orrick? Orrick is a global law firm focused on delivering innovative solutions for four sectors: Technology & Innovation, Energy & Infrastructure, Finance and Life Sciences & HealthTech. Founded more than 150 years ago in San Francisco, Orrick today has offices in 25+ markets. We are recognized globally for delivering the highest-quality legal advice and for our culture of innovation and collaboration. Compensation and Benefits The expected salary range for this position is: New York City and San Francisco $200,000 - $250,000 Orrick is committed to providing a comprehensive, competitive, and thoughtful total compensation package to our attorneys and staff, wherever they work. This compensation and benefits information is based on the Orrick's estimate as of the date of publication and may be modified in the future. The level of pay within the range will depend on a variety of job-related factors that may include, but not limited to, qualifications, relevant experience or education, particular skills or expertise, geography. Other compensation may include an annual discretionary merit bonus, which would be determined by Firm and individual performance. We offer a full range of elective health benefits including medical, dental, vision and life; robust mental well-being programs; child, family, elder, and pet care benefits; short- and long-term disability and industry leading parental leave benefits, health savings account contributions (w/applicable medical plan), flexible spending accounts, and a 401K program. This role will receive compensated time off through our Flexible Time Off program, and paid holidays. Please visit ************** for more information about the firm. How to Apply If you are searching for a chance to create an impact, you have a little grit and you love working with a team, we want to talk with you. To submit your resume and cover letter for this position, please visit our Staff and Paralegal Opportunities Listings at **************/Careers. Orrick accepts applications for this position on an ongoing basis, until filled. We are an Equal Opportunity Employer. Consistent with the SF Fair Chance Ordinance, an arrest and conviction record will not automatically disqualify a qualified applicant from consideration. #J-18808-Ljbffr

A global law firm is seeking a Senior Manager, Practice Information & Communication, based in New York or San Francisco. The role involves improving business development strategies and communication efforts within the Financial Services Litigation team. Candidates should have 8+ years of relevant experience, strong project management skills, and a proficiency in communication strategies. The position offers a competitive salary range of $200,000 - $250,000 and a comprehensive benefits package including health and wellness programs. #J-18808-Ljbffr

A global law firm is seeking a Senior Manager, Practice Information & Communication, based in New York or San Francisco. The role involves improving business development strategies and communication efforts within the Financial Services Litigation team. Candidates should have 8+ years of relevant experience, strong project management skills, and a proficiency in communication strategies. The position offers a competitive salary range of $200,000 - $250,000 and a comprehensive benefits package including health and wellness programs. #J-18808-Ljbffr

Orrick currently has an excellent opportunity on our Financial Services Litigation team for a Senior Manager, Practice Information & Communication, based in our New York or San Francisco office. In this role, you will use your understanding of complex litigation and financial services/private funds ecosystem to help one of the firm's leading practices accelerate its growth. This role presents an opportunity to deploy your strong written advocacy, project management, and analytical skills to make a business impact. Be part of a diverse team of recognized leaders in their field, with a strong passion for delivering the best for our clients and competing at the highest level. Responsibilities Carefully monitor the group's matters to identify opportunities to promote results for its first chairs and team. Optimize opportunities for collaboration. Collaborate with media relations resources (internal and external) to ensure optimal media and social media coverage of our results and our team, including AmLaw Litigators of the Week recognition. Support partners in sharing content via LinkedIn. Maintain a current database of coverage to leverage for marketing collateral. Draft and maintain all marketing collateral, including partner bios - ensuring they are up to date on our story, our results and feature media coverage. Draft and maintain website content about the practice. Develop and execute a thought leadership plan, publishing the minimum effective amount to support SEO and GEO results and give partners occasional opportunities to reach out to interested clients. Support the directory submission process, ensuring we submit our best results for all appropriate rankings and taking a strategic approach to advocating for the most important upward moves. Collaborate with the communications team to submit the group and its partners for media-driven awards. Collaborate with the events team to execute on all aspects of client entertainment and events in which the group participates. Develop content to share internally as appropriate to promote collaboration. Develop a plan of action and drive weekly meetings with the Chief Practice Officer and/or Practice Leader to refresh priorities and discuss progress. The role will collaborate with the firm's Communications, Events, Business Development, Talent, Research and Practice Management teams and all of the firm's other resources to deliver all of the above in a way that is tailored to the needs of the team and the clients and markets it serves. Qualifications Bachelor's degree or equivalent experience. 8+ years of experience in business development, marketing, or communications within legal, financial services, or private funds sectors. Strong understanding of complex litigation and the financial services/private funds ecosystem. Excellent written and verbal communication skills, with experience drafting marketing materials, thought leadership, and digital content. Ability to analyze matters and identify business development opportunities to promote results, optimize collaboration, and support business growth. Proven project management abilities, including managing multiple priorities and stakeholders. Demonstrated success in building collaborative relationships across teams and with firm leadership. Experience with media relations, event planning, and supporting directory submissions and awards. Client-focused approach with a commitment to delivering results. Proficiency with social media (especially LinkedIn) and familiarity with SEO and digital marketing. High level of professionalism, discretion, and adaptability in a fast-paced environment. Who is Orrick? Orrick is a global law firm focused on delivering innovative solutions for four sectors: Technology & Innovation, Energy & Infrastructure, Finance and Life Sciences & HealthTech. Founded more than 150 years ago in San Francisco, Orrick today has offices in 25+ markets. We are recognized globally for delivering the highest-quality legal advice and for our culture of innovation and collaboration. Compensation and Benefits The expected salary range for this position is: New York City and San Francisco $200,000 - $250,000 Orrick is committed to providing a comprehensive, competitive, and thoughtful total compensation package to our attorneys and staff, wherever they work. This compensation and benefits information is based on the Orrick's estimate as of the date of publication and may be modified in the future. The level of pay within the range will depend on a variety of job-related factors that may include, but not limited to, qualifications, relevant experience or education, particular skills or expertise, geography. Other compensation may include an annual discretionary merit bonus, which would be determined by Firm and individual performance. We offer a full range of elective health benefits including medical, dental, vision and life; robust mental well-being programs; child, family, elder, and pet care benefits; short- and long-term disability and industry leading parental leave benefits, health savings account contributions (w/applicable medical plan), flexible spending accounts, and a 401K program. This role will receive compensated time off through our Flexible Time Off program, and paid holidays. Please visit ************** for more information about the firm. How to Apply If you are searching for a chance to create an impact, you have a little grit and you love working with a team, we want to talk with you. To submit your resume and cover letter for this position, please visit our Staff and Paralegal Opportunities Listings at **************/Careers. Orrick accepts applications for this position on an ongoing basis, until filled. We are an Equal Opportunity Employer. Consistent with the SF Fair Chance Ordinance, an arrest and conviction record will not automatically disqualify a qualified applicant from consideration. #J-18808-Ljbffr

Nurse Manager - Patient Care Services (3 Openings) 📝 Contract: 13 Weeks 🔢 Openings: 3 ⏱ Hours: 40 hours/week | 5 days/week Available Positions & Shifts 1. Nurse Manager - PACU 🕓 Shift: 4:00 PM - 12:00 AM Requirements: Nurse Manager experience (required) PACU experience (required) BSN (required) 2. Nurse Manager - PACU 🕗 Shift: 8:00 AM - 4:00 PM Requirements: Nurse Manager experience (required) PACU experience (required) BSN (required) 3. Nurse Manager - OR 🕗 Shift: 8:00 AM - 4:00 PM Requirements: Nurse Manager experience (required) OR experience (required) BSN (required) Key Responsibilities Patient Care & Leadership Lead nursing practice using the Professional Practice Model and Modified Primary Nursing Care Delivery Model. Ensure consistent use of Purposeful Hourly Rounding (PHR) to enhance patient safety and patient experience. Conduct daily patient rounding (Monday-Friday) and validate staff compliance through observation and feedback. Assess staff competency, provide coaching, and deliver meaningful performance feedback. Communicate patient experience data and staff engagement insights to the interdisciplinary care team. Collaborate with physician leadership and escalate concerns appropriately. Address patient concerns promptly and provide service recovery as needed. Demonstrate compassion, respect, empathy, and active listening in all interactions. Patient Experience Role model patient-centered care practices including Admission Welcome, Bedside Shift Report, Medication Review, Discharge Wrap-Up, and MD/RN collaboration. Lead shift huddles to identify high-risk patients and ensure continuity of care. Interpret and communicate patient experience metrics, benchmarks, and improvement opportunities. Support culturally sensitive care aligned with patient values, preferences, and needs. Empower staff to use evidence-based practices to improve patient perceptions of care. Quality & Safety Promote a safe, efficient, and patient-centered care environment. Identify practice variances and participate in Root Cause Analysis (RCA) and corrective action planning. Foster a transparent culture that encourages reporting of errors and near-misses. Lead interdisciplinary quality improvement initiatives using high-reliability principles. Monitor compliance with quality, safety, and documentation standards. Ensure staff competency evaluations and mandated compliance requirements are met. Licensure & Certifications Active Registered Nurse (RN) License - New York State Language: English (Speak, Read, Write)

Job Title: Assistant Director of Nursing - Behavioral Health Shift: 8:00 AM - 4:00 PM Duration: 13 Weeks with possible extension Local Pay Range: $100 to $115/Hour Travel Pay Range: $3,800 - $4,500/Week Job Summary: · Plan and Develop programs to improve patient care and employee performance. · Monitor performance for patient care, assess units with nurse managers and communicate and assist with any corrective action. · Develop Record keeping system to record medication errors/counselling. Skills: · Seven (7) years of experience is required, Five (5) of which were in a supervisory role. . 2 years of experience in Behavioral Health. Education: · BSN - Required, MSN - Preferred. Certifications: · AHA BLS - Preferred. “Pride Health offers eligible employee's comprehensive healthcare coverage (medical, dental, and vision plans), supplemental coverage (accident insurance, critical illness insurance and hospital indemnity), 401(k)-retirement savings, life & disability insurance, an employee assistance program, legal support, auto, home insurance, pet insurance, and employee discounts with preferred vendors.

The Director of Nursing is responsible for planning, developing, and overseeing nursing programs to improve patient care quality and employee performance. This role ensures clinical excellence through performance monitoring, collaboration with nurse managers, and implementation of corrective actions when needed. The Director of Nursing also oversees record-keeping systems related to medication errors and patient counseling, ensuring compliance with regulatory and quality standards. Key Duties & Responsibilities Plan, develop, and implement nursing programs to enhance patient care outcomes and staff performance. Monitor patient care quality and nursing performance across units in collaboration with nurse managers. Conduct regular assessments of nursing units and provide guidance on corrective actions and performance improvement plans. Ensure compliance with clinical standards, policies, and regulatory requirements. Develop and maintain effective record-keeping systems for medication errors and patient counseling. Support staff development, education, and adherence to best nursing practices. Promote a culture of patient safety, accountability, and continuous quality improvement. Required Skills & Experience Minimum seven (7) years of nursing experience, with at least five (5) years in a supervisory or leadership role. Strong leadership, communication, and organizational skills. Proven ability to manage clinical operations and performance improvement initiatives. Education Required: Bachelor's degree in Nursing from an accredited nursing program Preferred: Master's degree in Nursing Certifications & Licensure Required: Active Registered Nurse (RN) License Primary Source Verification of RN license and registration from the New York State Department of Education (NYSED) Basic Life Support (BLS) certification Pride Health offers eligible employees comprehensive healthcare coverage (medical, dental, and vision plans), supplemental coverage (accident insurance, critical illness insurance, and hospital indemnity), 401(k) retirement savings, life & disability insurance, an employee assistance program, legal support, auto and home insurance, pet insurance, and employee discounts with preferred vendors.

Blue Earth Diagnostics is an established molecular imaging company focused on providing innovative, well-differentiated diagnostics solutions, informing patient management, and driving future therapies in cancer. Formed in 2014, Blue Earth Diagnostics' success is driven by our management expertise and agility, supported by our demonstrated track record of rapid development and commercialization of PET radiopharmaceuticals. Blue Earth Diagnostics' clinical focus is exclusively in cancer. Blue Earth Diagnostics is a subsidiary of Bracco Imaging S.p.A., a global leader in diagnostic imaging.Blue Earth Diagnostics is an established molecular imaging company focused on providing innovative, well-differentiated diagnostics solutions, informing patient management, and driving future therapies in cancer. Formed in 2014, Blue Earth Diagnostics' success is driven by our management expertise and agility, supported by our demonstrated track record of rapid development and commercialization of PET radiopharmaceuticals. Blue Earth Diagnostics' clinical focus is exclusively in cancer. Blue Earth Diagnostics is a subsidiary of Bracco Imaging S.p.A., a global leader in diagnostic imaging. - Job purpose Reporting to the CMO, the Medical Director - Clinical Development will provide medical expertise and strategic leadership to product development programs across the Bracco Molecular Imaging (MI) platform. Responsibilities will include providing medical and scientific leadership and input to product development strategies, product profile development, competitive positioning, and pipeline asset lifecycle. With relevant program/project teams, the Medical Director will realize strategic goals by developing and executing Blue Earth sponsored clinical trials across multiple jurisdictions to GCP standards, engaging with thought leaders and stakeholders, contribution to upholding and improvement of policies and processes and supporting cross-functional teams as required. You will collaborate with cross functional teams including medical affairs, regulatory, imaging, pharmacovigilance, non-clinical, clinical operations, biostatistics, editorial and commercial to achieve company goals. This is a remote position with a preference for candidates based in the Eastern or Central time zones. Main Responsibilities, Activities, Duties and Tasks Provide medical leadership within cross-functional Program Management Teams and projects related to clinical development. Provide medical expertise to BED/Bracco MI clinical development programs and strategy including Phase I to successful product approval, and lifecycle management. Activities include: Developing the product development strategy for pipeline assets with cross-functional partners Serving as the primary medical representative in regulatory interactions related to product development Developing clinical protocols, case report forms and clinical study reports for company sponsored programs, as well as medical review of other study-related documents (e.g. imaging charter, statistical analysis plan). Acting as medical monitor for company sponsored clinical studies where appropriate. Supporting the identification and recruitment of potential investigators for participation in Phase I-IV trials, and management of investigator relationships Tracking medical safety for clinical trials and providing medical support for pharmacovigilance activities, including individual case report assessment. Input and review of product investigator brochures and aggregate reports (e.g. development safety update reports) Verifying scientific accuracy of safety and efficacy summaries for regulatory/commercial purposes and assisting with the clinical sections of regulatory dossiers Medical and scientific oversight for Advisory Boards and Conference participation supporting clinical development activities. Providing key medical input into publications and acting as a company medical voice within publication steering committees and managing author relationships Providing strategic input and medical leadership in developing business cases for lifecycle opportunities with cross-functional partners within product development teams, especially medical affairs and commercial Communicating medical and product development strategy with key internal and external stakeholders. Responsibility for planned project activities, agreed upon and executed according to the milestones and the overall clinical development plan (including pre- and post-marketing activities) Interpreting clinical study data and clearly communicating results to internal and external stakeholders Medical input and direction to development of image acquisition and interpretation materials for pipeline assets. Work collaboratively with the New Assets Evaluation team in co-development of clinical development plans for potential new assets, as required. Work collaboratively with the Investigator Initiated Trials (IIT) team to define the IIT strategy and review proposals for pipeline assets Contribute to appropriate SOP and policy development related to product development Perform other duties and activities as assigned, including line management and acting as an internal imaging SME to provide ad-hoc support to medical affairs/commercial teams, in accordance with the needs of the business. Other duties as determined by business needs Education/Qualifications Medical Degree required Professional Experience, Knowledge, & Technical Skills Clinical care and research experience in the therapeutic areas in which BED has products/developmental assets, preferred. Minimum of five (5) years post Medical Degree experience, preferably with training and/or work experience in radiology or nuclear medicine, of which at least: Three (3) years are within the Pharmaceutical or Biotech Industry working in Clinical Development Understanding of the clinical trials and FDA approval processes, preferably with experience of FDA interactions. Experience in Real World Evidence / Observational research preferred Knowledge and understanding of US regulatory rules landscape (pertinent FDA Guidance for Industry). Strong business and product marketing acumen, vision and perspective. An ability to lead teams with or without management authority, empowering others while ensuring the quality of deliverables. Ability to comprehend and combine complex sets of data, spanning multiple projects and products/agents. Ability to handle multiple demands in a fast-paced environment and to interact within the context of multidisciplinary teams. Ability to work independently to manage the activities of the function and to be accountable for these activities. Able to effectively plan in the medium to long term. Able to proactively identify issues and problems, describe and assess risk and chances of product development success, and offer solutions and recommendations on product development issues. Able to make decisions under conditions of uncertainty. If required, able to manage, develop and recruit high quality personnel to form, develop and maintain highly effective teams. Ability to travel, domestic and international, estimated at approximately 30%, via airplane, train and/or motor vehicle will be required. Qualified candidate must be legally authorized to be employed in the United States. Annual Salary: $275,000.00-$325,000.00 Why Blue Earth Diagnostics? We are seeking motivated individuals with drive and determination to succeed in an innovative and respectful team environment. Our employees are empowered to achieve great things and thrive in our exceptionally co-operative culture. As a young and dynamic company experiencing rapid growth, Blue Earth Diagnostics prides itself on providing a clear focus and incentives to achieve our business-critical objectives. We aim to have fun and celebrate each milestone along the way. If you are seeking a job where you have a clear impact on business success, are working with talented and collaborative colleagues daily, and are doing something great for human healthcare, then this job is for you. Blue Earth Diagnostics offers a highly competitive salary for high-caliber candidates. We also offer a comprehensive benefits package including a complete healthcare plan, 401k with matching, work/life harmony, and generous paid holidays. Blue Earth Diagnostics is an equal opportunity employer. All qualified applicants will receive consideration for employment without discrimination on grounds of disability, age, race, color, religion, sex, national origin or any other characteristic protected by law.

The Physical Health Medical Director plays a key role within the Physical Health Medical Management Team, providing clinical oversight, medical expertise, and operational support for physical health services. This position ensures high quality, evidence based medical review processes and supports organizational goals related to clinical quality, utilization management, and care coordination. This position will allow the successful candidate to work primarily remote. While there is no expectation to be in the office routinely, the selected candidate may be required to report on-site as needed. It's strongly preferred that the selected candidate reside in North Carolina or be willing to relocate. This position may be required to work weekends and holidays based on organizational and operational requirements. Responsibilities & Duties Clinical Oversight & Medical Review Provide expert guidance and oversight for physical health service requests, including authorization of services and determination of appropriate level of care Ensure the integrity and quality of utilization management activities, including initial reviews, concurrent reviews, appeals, and level of care determinations for inpatient and outpatient services Participate in internal reviews of inpatient and outpatient clinical case types to ensure compliance with regulatory, accreditation, and organizational standards Review Approval and Denial of Service and Level of Care Requests Apply medical necessity criteria utilizing review criteria hierarchy for level of care and services regarding type, amount, and duration of service. Complete expected case volume as expected by the department Process Adherence, Quality & Efficiency Follow department processes-as defined by approved Alliance policies, desk procedures, and workflows referenced on the Alliance Grid and in the Medical Director OneNote-to complete timely utilization reviews in Alliance's UM platform and perform tasks efficiently Apply established workflows and maintain quality case reviews to ensure consistent decision making, documentation accuracy, and adherence to regulatory compliance Operational & Committee Support Support the Clinical Operations Department through active participation in organizational committees, including but not limited to Clinical Quality Review, Transition of Care Rounds, Overturn Committee Provide clinical guidance and leadership to promote collaboration between medical, behavioral, and care management teams External Engagement Participate in mediation activities and Office of Administrative Hearing (OAH) processes as required, providing clinical expertise and documentation support Additional Responsibilities Maintain awareness of regulatory requirements, utilization management guidelines, and emerging trends affecting utilization management and physical health services Contribute to process improvement initiatives aimed at enhancing clinical quality, efficiency, and member outcomes Support cross functional teams with medical expertise, as needed Provide consultation, training, and education to staff and community partners on relevant topics as needed Train and mentor peers within the Medical Management team and assist with onboarding PH Medical Director new hires as needed Maintain a Positive Environment Work with Human Resources and Medical Team to attract, maintain, and retain a highly qualified and well-trained workforce Actively establish and promote a positive, diverse, and inclusive working environment that builds trust with teammates Ensure all staff are treated with respect and dignity Ensure standards are transparent and applied consistently, impartially, and ethically over time and across all staff members Minimum Requirements Education & Experience Graduation from an accredited Medical School. M.D./D.O. degree is required and board certification in a relevant field. At least four (4) years of postgraduate clinical experience and two (2) or more years of managed care and utilization management experience are required. Special Requirement Current, active, and unrestricted license to practice medicine in North Carolina or meets qualifications to obtain a North Carolina Medical License with Board certification for appropriate field of Medicine (American Board of Family Medicine or American Board of Internal Medicine). Knowledge, Skills, & Abilities Knowledge of the information and techniques needed for diagnosis and treatment of medical issues, including symptoms, treatment alternatives, drug properties and interactions, and preventive health-care measures Knowledge of Managed Care Principles Knowledge of recent developments in the field of medicine Microsoft Office Skills Ability to speak with colleagues about treatment concerns, complex case issues and best practice recommendations Utilization Management experience Salary Range $211,172 - $269,245/Annually Exact compensation will be determined based on the candidate's education, experience, external market data and consideration of internal equity An excellent fringe benefit package accompanies the salary, which includes: Medical, Dental, Vision, Life, Long Term Disability Generous retirement savings plan Flexible work schedules including hybrid/remote options Paid time off including vacation, sick leave, holiday, management leave Dress flexibility

Location: This role requires associates to be in-office 3 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. Alternate locations may be considered. The Manager, Medical Director will serve as a clinical and strategic advisor to enterprise transformation programs spanning affordability, medical cost management, modernization, and growth initiatives. This role provides medical and clinical leadership to ensure that large-scale technology, operations, and product initiatives align with clinical best practices, regulatory requirements, and the organization's goals of affordability, quality, and innovation. The Medical Director will work closely with engineering, product, operations, and business leaders to shape transformation strategies, assess clinical and financial impacts, and guide implementation of initiatives that impact providers, members, and clients across the healthcare ecosystem. How you will make an impact: Strategic Clinical Leadership * Provide clinical insight and medical guidance across multiple enterprise transformation initiatives, including: * Medical Cost Management * HealthOS and enterprise data platforms * Real-time Decisioning & Analytics (RDA) * Cost of Care / Payment Integrity * Care Management / Utilization Management (CM/UM) Modernization * Provider Networking & Modernization * Value-Based Care and Carelon Risk models * Carelon Research & Data Commercialization * Client Information Insights and CDIP/Consumer Experience * Advise on Teradata/SAS migration and retirement, ensuring data modernization supports clinical and operational needs. * Translate complex clinical and regulatory requirements into actionable technical and operational strategies. Program & Initiative Support * Partner with SVRO (Strategic Value Realization Office) and enterprise transformation leaders to assess clinical and medical cost implications of strategic initiatives. * Evaluate program designs for alignment with quality, safety, and evidence-based clinical practice. * Guide affordability-focused programs with a balance of cost containment, care quality, and provider/member experience. Collaboration & Influence * Collaborate with engineering, analytics, and product teams to ensure platforms such as HealthOS and RDA incorporate clinical intelligence and deliver actionable insights. * Advise Carelon Research and Data Commercialization teams on ethical and clinically appropriate use of healthcare data. * Partner with Provider Network leaders to shape modernization strategies that drive value-based outcomes and affordability. * Serve as a clinical voice in modernization of CM/UM platforms, ensuring alignment with regulatory mandates and member engagement expectations. Regulatory & Compliance Oversight * Ensure compliance with clinical, accreditation, and regulatory standards across transformation programs. * Support interpretation of federal/state mandates and advise on clinical implementation strategies. 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. Preferred Qualifications: * 5+ years of clinical practice experience, with transition into payer, managed care, or healthcare leadership preferred. * Experience advising medical cost management, utilization management, payment integrity, or provider performance programs preferred. * Strong understanding of healthcare data systems (claims, EHR, analytics platforms) and payer operations preferred. * Proven ability to influence cross-functional teams and guide complex, enterprise-level initiatives. * Prior leadership in a payer, health plan, or healthcare innovation organization preferred. * Familiarity with enterprise platforms such as Teradata, SAS, or cloud-based data ecosystems. * Experience in value-based care, population health, and care management program design preferred. * Understanding research and data commercialization within healthcare. * Ability to communicate effectively with technical, clinical, and executive stakeholders. For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $291,900 to $500,400 Locations: California, Colorado, District of Columbia (Washington, DC) Illinois, New Jersey, New York, Washington State In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws. * The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law. 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. 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 and Influenza. 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 ******************************************** for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

Location: This role requires associates to be in-office 3 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. Alternate locations may be considered. The Manager, Medical Director will serve as a clinical and strategic advisor to enterprise transformation programs spanning affordability, medical cost management, modernization, and growth initiatives. This role provides medical and clinical leadership to ensure that large-scale technology, operations, and product initiatives align with clinical best practices, regulatory requirements, and the organization's goals of affordability, quality, and innovation. The Medical Director will work closely with engineering, product, operations, and business leaders to shape transformation strategies, assess clinical and financial impacts, and guide implementation of initiatives that impact providers, members, and clients across the healthcare ecosystem. How you will make an impact: Strategic Clinical Leadership * Provide clinical insight and medical guidance across multiple enterprise transformation initiatives, including: * Medical Cost Management * HealthOS and enterprise data platforms * Real-time Decisioning & Analytics (RDA) * Cost of Care / Payment Integrity * Care Management / Utilization Management (CM/UM) Modernization * Provider Networking & Modernization * Value-Based Care and Carelon Risk models * Carelon Research & Data Commercialization * Client Information Insights and CDIP/Consumer Experience * Advise on Teradata/SAS migration and retirement, ensuring data modernization supports clinical and operational needs. * Translate complex clinical and regulatory requirements into actionable technical and operational strategies. Program & Initiative Support * Partner with SVRO (Strategic Value Realization Office) and enterprise transformation leaders to assess clinical and medical cost implications of strategic initiatives. * Evaluate program designs for alignment with quality, safety, and evidence-based clinical practice. * Guide affordability-focused programs with a balance of cost containment, care quality, and provider/member experience. Collaboration & Influence * Collaborate with engineering, analytics, and product teams to ensure platforms such as HealthOS and RDA incorporate clinical intelligence and deliver actionable insights. * Advise Carelon Research and Data Commercialization teams on ethical and clinically appropriate use of healthcare data. * Partner with Provider Network leaders to shape modernization strategies that drive value-based outcomes and affordability. * Serve as a clinical voice in modernization of CM/UM platforms, ensuring alignment with regulatory mandates and member engagement expectations. Regulatory & Compliance Oversight * Ensure compliance with clinical, accreditation, and regulatory standards across transformation programs. * Support interpretation of federal/state mandates and advise on clinical implementation strategies. 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. Preferred Qualifications: * 5+ years of clinical practice experience, with transition into payer, managed care, or healthcare leadership preferred. * Experience advising medical cost management, utilization management, payment integrity, or provider performance programs preferred. * Strong understanding of healthcare data systems (claims, EHR, analytics platforms) and payer operations preferred. * Proven ability to influence cross-functional teams and guide complex, enterprise-level initiatives. * Prior leadership in a payer, health plan, or healthcare innovation organization preferred. * Familiarity with enterprise platforms such as Teradata, SAS, or cloud-based data ecosystems. * Experience in value-based care, population health, and care management program design preferred. * Understanding research and data commercialization within healthcare. * Ability to communicate effectively with technical, clinical, and executive stakeholders. For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $291,900 to $500,400 Locations: California, Colorado, District of Columbia (Washington, DC) Illinois, New Jersey, New York, Washington State In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws. * The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law. 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. 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 and Influenza. 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 ******************************************** for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

Location: This role requires associates to be in-office 3 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. Alternate locations may be considered. The Manager, Medical Director will serve as a clinical and strategic advisor to enterprise transformation programs spanning affordability, medical cost management, modernization, and growth initiatives. This role provides medical and clinical leadership to ensure that large-scale technology, operations, and product initiatives align with clinical best practices, regulatory requirements, and the organization's goals of affordability, quality, and innovation. The Medical Director will work closely with engineering, product, operations, and business leaders to shape transformation strategies, assess clinical and financial impacts, and guide implementation of initiatives that impact providers, members, and clients across the healthcare ecosystem. How you will make an impact: Strategic Clinical Leadership * Provide clinical insight and medical guidance across multiple enterprise transformation initiatives, including: * Medical Cost Management * HealthOS and enterprise data platforms * Real-time Decisioning & Analytics (RDA) * Cost of Care / Payment Integrity * Care Management / Utilization Management (CM/UM) Modernization * Provider Networking & Modernization * Value-Based Care and Carelon Risk models * Carelon Research & Data Commercialization * Client Information Insights and CDIP/Consumer Experience * Advise on Teradata/SAS migration and retirement, ensuring data modernization supports clinical and operational needs. * Translate complex clinical and regulatory requirements into actionable technical and operational strategies. Program & Initiative Support * Partner with SVRO (Strategic Value Realization Office) and enterprise transformation leaders to assess clinical and medical cost implications of strategic initiatives. * Evaluate program designs for alignment with quality, safety, and evidence-based clinical practice. * Guide affordability-focused programs with a balance of cost containment, care quality, and provider/member experience. Collaboration & Influence * Collaborate with engineering, analytics, and product teams to ensure platforms such as HealthOS and RDA incorporate clinical intelligence and deliver actionable insights. * Advise Carelon Research and Data Commercialization teams on ethical and clinically appropriate use of healthcare data. * Partner with Provider Network leaders to shape modernization strategies that drive value-based outcomes and affordability. * Serve as a clinical voice in modernization of CM/UM platforms, ensuring alignment with regulatory mandates and member engagement expectations. Regulatory & Compliance Oversight * Ensure compliance with clinical, accreditation, and regulatory standards across transformation programs. * Support interpretation of federal/state mandates and advise on clinical implementation strategies. 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. Preferred Qualifications: * 5+ years of clinical practice experience, with transition into payer, managed care, or healthcare leadership preferred. * Experience advising medical cost management, utilization management, payment integrity, or provider performance programs preferred. * Strong understanding of healthcare data systems (claims, EHR, analytics platforms) and payer operations preferred. * Proven ability to influence cross-functional teams and guide complex, enterprise-level initiatives. * Prior leadership in a payer, health plan, or healthcare innovation organization preferred. * Familiarity with enterprise platforms such as Teradata, SAS, or cloud-based data ecosystems. * Experience in value-based care, population health, and care management program design preferred. * Understanding research and data commercialization within healthcare. * Ability to communicate effectively with technical, clinical, and executive stakeholders. For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $291,900 to $500,400 Locations: California, Colorado, District of Columbia (Washington, DC) Illinois, New Jersey, New York, Washington State In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws. * The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law. 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. 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 and Influenza. 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 ******************************************** for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations could be considered. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. Work schedule: Monday - Friday. Half day Saturday rotation, once a month. The Behavioral Health Medical Director-Psychiatrist Appeals is responsible for the administration of 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. How you will make an impact: * Supports clinicians to ensure timely and consistent responses to members and providers. * Provides guidance for clinical operational aspects of a program. * 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. * Provides 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. * Typically has program management responsibilities including clinical policy development, improvement of quality, cost, and outcomes, program development/implementation, and overseeing clinical/non-clinical activities. Minimum Qualifications: * 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. Preferred Skills, Capabilities and Experiences: * Child and Adolescent experience strongly preferred. * Utilization Management experience. * Applied Behavior Analysis (ABA) experience. For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $250,236 to $428,976. Locations: California; Colorado; District of Columbia (Washington, DC), Illinois, New Jersey; Maryland, Minnesota, Nevada; New York. In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws. * The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law. 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. 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 and Influenza. 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 ******************************************** for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

OUR COMMITMENT TO A HUMAN HIRING PROCESS We believe every candidate deserves thoughtful consideration. That's why we do not use AI or automated systems to review applications. Every application is reviewed by a real human member of our team. Because we take the time to give each submission the attention it deserves, our review process may take a little longer - and we genuinely appreciate your patience as we work through applications carefully and respectfully. SERVICE AREA PREFERENCE While we encourage all interested applicants to apply, we do give priority to those who live in, or near, our service counties: Santa Cruz, Monterey, Merced, San Benito, and Mariposa. Our mission of accessible, quality health care guided by local innovation leads everything we do, and having team members who are connected to the communities we serve strengthens our ability to deliver on that commitment. *This is a hybrid position with the expectation to work in our service area(s) 2-3 days per month. The Alliance service area includes Santa Cruz, Monterey, Merced, San Benito, and Mariposa counties. We have an opportunity to join the Alliance as the Medicare Medical Director (MD). WHAT YOU'LL BE RESPONSIBLE FOR Reporting to the Chief Medical Officer, this position: Acts as the Alliance's Medicare Dual Eligible Special Needs Plan (D-SNP) clinical subject matter expert Provides specialized clinical D-SNP leadership within a variety of Health Services functional areas Develops and improves relationships with internal and external stakeholders, including the professional medical community, and maintains and enhances communications with similar Health Plan organizations Participates in all aspects of regulatory compliance related to D-SNP and Health Services functions THE IDEAL CANDIDATE Enjoys a fast-paced, demanding environment that requires critical thinking to develop and implement effective solutions in a timely manner Is dedicated to caring for Medicare and/or Medicaid patients while addressing the social determinants of health Works with a broad and diverse group of stakeholders to problem solve and build cutting-edge programs Has the latitude to think broadly, make operational and strategic decisions, and oversee the implementation and continuous process improvement related to key internal and external priorities WHAT YOU'LL NEED TO BE SUCCESSFUL To read the full position description, and list of requirements click here. Knowledge of: The needs of the Medicare population and/or Medicare Plan administration The Medicare D-SNP program and related regulations, CMS D-SNP STARS Rating System, and managed care Medical programs administration, quality improvement, and/or informatics Data collection and management practices, as related to utilization and quality of medical care Promoting and applying change management principles Ability to: Provide clinical oversight and leadership of the Medicare D-SNP program Analyze issues and think critically to ensure success in leading system change, make informed operational and strategic decisions, and oversee implementation and continuous process improvement related to key internal and external priorities Audit, analyze, and assess medical records and other health care data Interpret regulations, legal and contractual language, policies, and procedures Education and Experience: Doctor of Medicine, current license to practice medicine issued by the State of California, Board certification in a specialty recognized by the American Board of Medical Specialties, and a minimum of three years of experience as an attending physician with the Medicare population or three years of experience as an attending physician which included a minimum of two years of Medicare Plan administration experience; or an equivalent combination of education and experience may be qualifying OTHER INFORMATION We are in a hybrid work environment and we anticipate that the interview process will take place remotely via Microsoft Teams. While some staff may work full telecommuting schedules, attendance at quarterly company-wide events or department meetings will be expected. In-office or in-community presence may be required for some positions and is dependent on business need. Details about this can be reviewed during the interview process. The full compensation range for this position is listed by location below. The actual compensation for this role will be determined by our compensation philosophy, analysis of the selected candidate's qualifications (direct or transferrable experience related to the position, education or training), as well as other factors (internal equity, market factors, and geographic location). Typical areas in Zone 1: Bay Area, Sacramento, Los Angeles area, San Diego area Typical areas in Zone 2: Fresno area, Bakersfield, Central Valley (with the exception of Sacramento), Eastern California, Eureka area Zone 1 (Monterey, San Benito and Santa Cruz) $296,164 - $473,866 USD Zone 2 (Mariposa and Merced) $269,500 - $431,205 USD OUR BENEFITS Medical, Dental and Vision Plans Ample Paid Time Off 12 Paid Holidays per year 401(a) Retirement Plan 457 Deferred Compensation Plan Robust Health and Wellness Program Onsite EV Charging Stations And many more ABOUT US We are a group of over 500 dedicated employees, committed to our mission of providing accessible, quality health care that is guided by local innovation. We feel that our work is bigger than ourselves. We leave work each day knowing that we made a difference in the community around us. The Alliance is an equal employment opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), sexual orientation, gender perception or identity, national origin, age, marital status, protected veteran status, or disability status. We are an E-Verify participating employer Join us at Central California Alliance for Health (the Alliance) is an award-winning regional Medi-Cal managed care plan that provides health insurance for children, adults, seniors and people with disabilities in Mariposa, Merced, San Benito and Santa Cruz counties. We currently serve more than 418,000 members. To learn more about us, take a look at our Fact Sheet. At this time the Alliance does not provide any type of sponsorship. Applicants must be currently authorized to work in the United States on a full-time, ongoing basis without current or future needs for any type of employer supported or provided sponsorship.

Clinical Operations Medical Director Carelon Medical Benefit Management Radiation Oncology Virtual: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. A proud member of the Elevance Health family of companies, Carelon Medical Benefits Management, formerly AIM Specialty Health, is a benefit-management leader in Illinois. Our platform delivers significant cost-of-care savings across an expanding set of clinical domains, including radiology, cardiology and oncology. The Clinical Operations Medical Director is responsible for supporting the medical management staff ensuring timely and consistent medical decisions to members and providers. How you will make an impact: * Ensures timely completion of clinical case reviews for their board certified specialty. * Makes physician to physician calls to gather medical appropriate information in order to make medical necessity determinations for services requested. * Makes medical necessity determinations for grievance and appeals appropriate for their specialty. * Ensures consistent use of company medical policies when making medical necessity decisions. * Brings to their supervisors attention, any case review decisions that require Medical Director review or policy interpretation. Mimimum 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. * Minimum of 1 year of experience with clinical case reviews for medical necessity. The minimum of 1 year of experience with clinical case reviews would be waived for the following specific specialties only; Cardiology, Oncology, and Interventional Pain specialties. Board certification in a medical specialty required. Preferred Skills, Capabilities, and Expereinces * Board certified in Radiation Oncology strongly preferred For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $225,036 to $352,236 Locations: California; District of Columbia (Washington, DC), New Jersey, New York, In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws. * The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law. 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. 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 and Influenza. 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 ******************************************** for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

Medical Cost AI Intelligence Director (IT Strategy & Planning Director) Location: This role requires associates to be in-office 3 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. Alternate locations may be considered if candidate resides within a commutable distance from an office. The Medical Cost AI Intelligence Director is responsible for strategy, planning and execution of technology solutions to proactively manage medical costs through the use of AI & analytics focused capabilities to drive affordable healthcare across the industry. The role will also be responsible for comprehensively looking at the provider and payer landscape to identify and drive innovative approaches for understanding medical cost trends, provider behavior, provider billing behavior, and healthcare industry operations to streamline medical costs for health plan members. How you will make an impact: * Develop and execute overall technology, inclusive of AI & analytics, strategies at the enterprise level driving alignment across various business unites to ensure enterprise financial goals & priorities are enables by technology delivery. * Partners with senior planning leaders and executive leadership to create sound multi year plans with clear planning assumptions and accurate financial insights for the technology function. * Monitors and conducts research of related technology and business trends, using data and qualitative performance measures, to advise senior management relative to IT strategy. * Synthesizes annual and multi-year plans to demonstrate tie-back to corporate and senior leadership-level strategies and goals. * Conduct external research and engage partners across multiple departments within the broader enterprise to frame up potential strategic initiatives for investment or execution support. * Use forecast models and scenario analysis to analyze performance and develop action plans to address emerging market and technological opportunities. * Researches new ventures and prospective service expansion opportunities. Create executive reports that decipher complex technical issues. Minimum Requirements: Requires an BA/BS degree in Information Technology, Computer Science or related field of study and a minimum of 10 years experience in Data Collection and Analysis, IT Consulting, IT Performance Management, Strategy or Financial Planning, Business Intelligence and Analytics, or Business Process Design; or any combination of education and experience, which would provide an equivalent background. Preferred Skills, Capabilities, and Experiences: * Healthcare experience within the provider systems, healthcare insurers , or services companies that support providers systems or healthcare insurers strongly preferred. * Experience implementing analytics solutions including use of advance AI/ML techniques strongly preferred. For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $178,200 to $291,600. Locations: California, District of Columbia (Washington DC), Illinois, New York In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the company. The company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws. * The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law. 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. 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 and Influenza. 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 ******************************************** for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.