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Manager, Medical Director – Transformation Initiatives

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 [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.