Medical Director-Long Term Support and Services-Mycare OHIO

Anticipated End Date:

2025-11-14

Position Title:

Medical Director -Long Term Support and Services- MyCare OHIO

Job Description:

Medical Director -Long Term Support and Services- MyCare OHIO

Preferred Location: Ohio.

The Medical Director -Long Term Support and Services- MyCare OHIO is responsible for (LTSS) supporting the MyCare OH program, focusing on oversight of managed long-term services and supports, and including physical and behavioral health services for older adults and adults with physical disabilities to ensure the appropriate level of care is received. This role will serve as a key leader on the LTSS leadership team, working closely with local LTSS clinical leaders to execute comprehensive care plans and services for members. May be responsible for developing and implementing programs to improve quality, utilization trends, and member outcomes. May provide clinical consultation and serve as clinical/strategic advisor to clinical operations including utilization management, care management and quality management in support of the MyCare OH program

How will you make an impact: 

• MLTSS Medical Director will be instrumental in driving innovation and effectiveness in long-term care services.
• Oversee all primary and physical health services provided to individuals of the health plan, including those receiving LTSS, ensuring the appropriate level of medical care is received.  Identifies potential issues, project change, and scope data.
• Ensure services align with LTSS clinical and service coordination requirements as defined by state and federal contracts/rules. 
• Perform peer-to-peer calls for the general and specialized populations.
• Interpret existing policies and develop new ones based on healthcare changes like evolving best practices or changes to Market and/or Federal policy.
• Lead clinical and non-clinical activities impacting healthcare quality, cost, and outcomes.
• This role will serve as a key leader on LTSS leadership team, working closely with local LTSS leaders to execute strategic quality and cost of care plans.
• Involved in quality-of-care initiative development, including hospice and home health care reviews.
• Conduct targeted LTSS Case Management training sessions, emphasizing the most prevalent medical diagnoses affecting the key LTSS populations.
• Assist with resource development and drive Health Plan collaborations to support LTSS/HCBS populations. 
• Supports clinicians to ensure timely and consistent responses to members and providers.
• May provide clinical consultation and serve as clinical/strategic advisor to enhance clinical operations

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.
• A 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, a 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:

• Minimum of ten years of clinical experience, including at least five years of experience directing healthcare services for target populations strongly preferred.
• 1-2 years Utilization Management experience strongly preferred.
• Strong oral, written, and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

Job Level:

Director Equivalent

Workshift:

1st Shift (United States of America)

Job Family:

MED > Licensed Physician/Doctor/Dentist

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 [email protected] 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.