Clinical Ops Medical Director - Virtual Role

Elevance Health; Mason (OH); Remote; USD 124,000 - 203,000; Full time

Job summary

Elevance Health's Carelon Medical Benefits Management seeks a Clinical Operations Associate Medical Director to support medical management staff and ensure timely, consistent medical decisions for members and providers.

Requires MD/DO with board certification (ABMS or AOA) and an active unrestricted medical license. Salary range is $89.78–$147.49 per hour for listed locations, with virtual work and occasional in-person training; alternate locations may be considered near a commuting distance.

Qualifications

• Requires MD/DO with board certification (ABMS or AOA).
• Active unrestricted medical license to practice medicine.
• Board-certified in Family or Internal Medicine strongly preferred.

Responsibilities

• Ensures timely completion of clinical case reviews for their specialty.
• Makes physician-to-physician calls to gather information to determine medical necessity.
• Makes medical necessity determinations for grievances and appeals.
• Ensures consistent use of medical policies when making decisions.
• Notifies supervisors of cases requiring Medical Director review or policy interpretation.

Skills

Board-certified in Family or Internal?

Education

MD/DO

Job description

Elevance Health's Carelon Medical Benefits Management seeks a Clinical Operations Associate Medical Director to support medical management staff and ensure timely, consistent medical decisions for members and providers.

Requires MD/DO with board certification (ABMS or AOA) and an active unrestricted medical license. Salary range is $89.78–$147.49 per hour for listed locations, with virtual work and occasional in-person training; alternate locations may be considered near a commuting distance.