Florida Medicare Medical Director — Remote Onsite Training

Elevance Health, Inc.; Tampa (FL); À distance; USD 240 000 - 320 000; Plein temps

Avantages offerts par ce poste

Hybrid work model

Vaccination program

Résumé du poste

Elevance Health is seeking a Medical Director for Florida Medicare to oversee utilization management, clinical reviews, and cost-of-care initiatives. The role combines clinical leadership with committee participation and adherence to Medicare timelines, including weekend coverage.

Hybrid-remote work with in-person trainings is expected, preference for Florida-based candidates within commuting distance. The position requires an MD or DO with board certification, Florida license, and at least 10

Qualifications

• Requires MD or DO with ABMS/AOA board certification.
• Active unrestricted Florida medical license required.
• Minimum of 10 years clinical experience or equivalent.
• For Health Solutions and Carelon: minimum of 5 years healthcare experience.

Responsabilités

• Perform utilization management reviews to determine medical necessity and appropriateness of care.
• Collaborate with UM nurses and case managers to review admissions and continued stays.
• Provide peer-to-peer discussions with treating physicians on medical necessity decisions.
• Lead and participate in clinical and non-clinical initiatives impacting quality and cost of care.
• Represent company on external committees and lead internal committees as needed.
• Ensure timely reviews in compliance with regulations and company standards.
• Weekend and holiday coverage as part of UM operations.

Connaissances

Utilization management

Medical necessity reviews

Peer-to-peer discussions

Clinical guidance

Committees participation

Weekend on-call

Formation

MD or DO with board certification

Outils

MCG criteria

InterQual

CMS guidelines

Description du poste

Elevance Health is seeking a Medical Director for Florida Medicare to oversee utilization management, clinical reviews, and cost-of-care initiatives. The role combines clinical leadership with committee participation and adherence to Medicare timelines, including weekend coverage.

Hybrid-remote work with in-person trainings is expected, preference for Florida-based candidates within commuting distance. The position requires an MD or DO with board certification, Florida license, and at least 10