Florida Medicare Medical Director (Part-Time)

Elevance Health (Anthem); Miami (FL); Hybride; USD 120 000 - 180 000; Temps partiel

Résumé du poste

Elevance Health in Florida seeks a Medical Director for Florida Medicare on a part-time basis. The role requires leadership in utilization management, clinical reviews, and collaboration with UM nurses and physicians.

You will participate in committees, guide clinical operations, and ensure timely reviews in line with NCQA and CMS guidelines. Remote-friendly with required in-person training, located near Florida preferred.

Qualifications

• Requires MD or DO with ABMS/AOA board certification where applicable.
• Active unrestricted Florida medical license is required.
• Must reside in the United States for UR/appeals reviews.
• Minimum 10 years of clinical experience; 5 years for Health Solutions/Carelon contracts.

Responsabilités

• Lead utilization management and medical necessity reviews for inpatient and outpatient care.
• Conduct peer-to-peer discussions with treating physicians.
• Participate in committees (peer review, credentialing, quality).
• Represent the company with external entities when needed.

Connaissances

Clinical leadership

Utilization management

Peer to peer discussions

Formation

MD/DO

Description du poste

Elevance Health in Florida seeks a Medical Director for Florida Medicare on a part-time basis. The role requires leadership in utilization management, clinical reviews, and collaboration with UM nurses and physicians.

You will participate in committees, guide clinical operations, and ensure timely reviews in line with NCQA and CMS guidelines. Remote-friendly with required in-person training, located near Florida preferred.