Associate Medical Director- DMEPOS

elevancehealth; Nashville (TN); Remote; USD 180,000 - 240,000; Full time

Job summary

Elevance Health is seeking a Clinical Operations Associate Medical Director – DMEPOS to support medical management staff in delivering timely, medically sound determinations on DME requests. The role involves physician-to-physician communications, adherence to medical policies, and potential escalation for policy interpretation.

The position is primarily remote with in-person training as required; candidates should hold an MD/DO with ABMS/AOA board certification and an active unrestricted

Qualifications

• MD/DO and board certification approved by ABMS or AOA, active unrestricted medical license.

Responsibilities

• Support medical management staff to ensure timely and consistent medical decisions for DME.
• Complete clinical case reviews for the board-certified specialty in a timely manner.
• Make physician-to-physician calls to gather information for medical necessity determinations.
• Determine medical necessity for grievances and appeals according to policies.
• Escalate decisions requiring Medical Director review or policy interpretation to supervisors.

Education

MD/DO with ABMS/AOA board certification (active, unrestricted)

Job description

Anticipated End Date: 2026-10-02

Position Title: Associate Medical Director- DMEPOS

Job Description

Clinical Operations Associate Medical Director

Carelon Medical Benefits Management

DME

Schedule: 8-5 Central Time Monday-Friday

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. Alternate locations may be considered if candidates reside within a commuting distance from an office.

• 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.

The Clinical Operations Associate Medical Director - DMEPOS will be responsible for supporting the medical management staff ensuring timely and consistent medical decisions to members and providers primarily regarding DME.

• 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 medical policies when making medical necessity decisions.
• Brings to their supervisors attention, any case review decisions that require Medical Director review or policy interpretation.

Minimum Requirements

Requires MD/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.

Preferred Skills, Capabilities and Experiences

• Board certification in Family Medicine, Internal Medicine, or PM&R preferred.
• Additional State Licensure may be required to obtain after hire

Job Level: Non-Management Non-Exempt

Job Family: MED > Licensed Physician/Doctor/Dentist

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 should submit the following form: Accessibility Accommodation Request Form and a member of the team will be in contact. 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.

Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration.

NOTE

Workday keeps job postings active through 11:59:59 PM on the day before the listed end date. Example: If the end date is 3/13, the posting will automatically come down on 3/12 at 11:59:59 PM. In other words — the job is posted until 3/13, not through 3/13.