Anthem Blue Cross is a proud member of the Elevance Health's family of companies offering Medicare plans, Medicaid, individual and family plans, and group insurance plans in California. Our group plans include a variety of group medical, pharmacy, dental, vision, life and disability plans, and are flexible enough to fit any size business.

The Medical Director is responsible for the administration of physical and/or behavioral health medical services, to ensure the appropriate and most cost effective medical care is received.

Location: This is a hybrid role and will require 1 day per week in the Woodland Hills, CA office.

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.

• Conducts peer-to-peer clinical reviews with attending physicians or other providers to discuss review determinations, and patients office visits with providers and external physicians.

• Conducts 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.

• Represents the company to external entities and/or serve on internal and/or external committees. May chair company committees.

• Interprets medical policies and clinical guidelines.

• Develops and proposes 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.

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 pediatric or family medicine 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:

• California Children Services (CCS) experience strongly preferred.

• Whole member/integrated care experience strongly preferred.

For candidates working in person or remotely in the below locations, the salary* range for this specific position is $263,503 - $395,254

Locations: California

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.