Medical Director Associate

Elevance Health; Northern (KY); Hybrid; USD 123,000 - 235,000; Full time

Job summary

Elevance Health is seeking a physician leader to support medical services for its health plans and to provide clinical guidance, peer-to-peer reviews, and timely, evidence-informed determinations.

This contract-to-hire role operates in a hybrid workforce, requires an MD/DO with board certification, an active medical license, and a minimum of five years of clinical experience; duties include reviews, credentialing support, and collaboration with Medical Directors.

Qualifications

• Requires MD or DO and Board certification approved by ABMS or AOA where applicable.
• Must possess an active unrestricted medical license to practice medicine.
• Minimum of 5 years of clinical experience or equivalent background.
• Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving, facilitation, and analytical skills.

Responsibilities

• Provide clinical guidance for programs and support clinicians for timely responses to members and providers.
• Conduct peer-to-peer clinical reviews with physicians to discuss determinations and patient visits.
• Conduct peer-to-peer clinical appeal case reviews as needed.
• Possibly participate in a physician on-call rotation for a 24x7 unit.
• Assist in practitioner appeal reviews, appropriateness criteria reviews, and medical technology assessments.

Skills

Clinical guidance

Peer-to-peer reviews

Medical policy interpretation

Interpersonal communication

Medical decision making

Education

MD/DO

Board certification (ABMS/AOA)

Job description

Please note this is the target date and is subject to change. BCForward will send official notice ahead of a confirmed start date.

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.

Primary duties may include, but are not limited to:

• May provide clinical guidance for programs. Supports clinicians to ensure timely and consistent responses to members and providers.
• Conducts peer-to-peer clinical reviews with attending physicians or other ordering providers to discuss review determinations, and patients' office visits with providers and external physicians.
• May conduct peer-to-peer clinical appeal case reviews with attending physicians or other ordering providers to discuss review determinations.
• May participate in a physician on-call rotation for a 24x7 unit.
• May assist in the practitioner appeal reviews, appropriateness criteria reviews, medical technology assessments, setting and implementing QI initiatives, and practitioner/provider credentialing.
• Under direction, may be responsible for the administration of medical services for company health plans including medical policies.
• Serves as a resource and consultant to other areas of the company.
• May interpret existing medical policy.
• May be required to represent the company to external entities and/or serve on internal and/or external committees.
• This level typically is more of a supportive position with oversight from a Medical Director.
• May be responsible for a portion of a clinical program and/or performing clinical reviews. Is more involved in supporting one or more Medical Directors, as well as the programs to which the Medical Director is assigned.
• May manage pieces of programs but would not have the full scope of program management expected of the Medical Director.
• Receives guidance and oversight from a Medical Director who is an individual contributor in addition to direction received from immediate manager.
• Ensures timely completion of clinical case reviews for post-acute care.
• 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 supervisor’s attention, any case review decisions that require Medical Director review or policy interpretation.

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 5 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.

Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

Job Type

Possible Contract to hire

Working hours

Monday–Friday between the hours of 7AM -7PM CST. Full-time hours, Minimum of 40 hours per week.

Option for weekend work (as available/needed; scheduling to be determined)

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, contractors 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. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.

About BCForward

Founded in 1998 on the idea that industry leaders needed a professional service, and workforce management expert, to fuel the development and execution of core business and technology strategies, BCforward is a Black-owned firm providing unique solutions supporting value capture and digital product delivery needs for organizations around the world. Headquartered in Indianapolis, IN with an Offshore Development Center in Hyderabad, India, BCforward's 6,000 consultants support more than 225 clients globally.

BCforward champions the power of human potential to help companies transform, accelerate, and scale. Guided by our core values of People-Centric, Optimism, Excellence, Diversity, and Accountability, our professionals have helped our clients achieve their strategic goals for more than 25 years. Our strong culture and clear values have enabled BCforward to become a market leader and best in class place to work.

BCForward is an equal opportunity employer

BCForward is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin or protected veteran status and will not be discriminated against based on disability.

To learn more about how BCforward collects and uses personal information as part of the recruiting process, view our Privacy Notice and CCPA Addendum. As part of the recruitment process, we may ask for you to disclose and provide us with various categories of personal information, including identifiers, professional information, commercial information, education information, and other related information. BCforward will only use this information to complete the recruitment process.

This posting is not an offer of employment. All applicants applying for positions in the United States must be legally authorized to work in the United States. The submission of intentionally false or fraudulent information in response to this posting may render the applicant ineligible for the position. Any subsequent offer of employment will be considered employment at-will regardless of the anticipated assignment duration.

Pay Rate Range

Min Pay Rate $89.44

Max Pay Rate $170.79

Currency USD

Unit hourly

The pay range is the range BCForward 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.

Benefits Information

BCForward offers all eligible employees a comprehensive benefits package including, but not limited to major medical, HSA, dental, vision, employer-provided group life, voluntary life insurance, short-term disability, long-term disability, and 401k.

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. This does not encompass additional non-standard compensation (e.g., benefits, paid time off, per diem, etc.).