Medical Director Associate – CarelonRx

Elevance Health; Indianapolis (IN); Hybrid; USD 180,000 - 240,000; Full time

Job summary

Elevance Health is seeking a Medical Director Associate for CarelonRx to lead pharmacy prior authorization reviews and ensure regulatory compliance. The role supports clinicians to provide timely responses to members and providers, with peer-to-peer discussions and an on-call weekend rotation for a 24x7 unit.

Qualified candidates hold an MD or DO with ABMS/AOA board certification, an active unrestricted medical license, and at least 5 years of clinical experience.

Qualifications

• MD or DO required with board certification (ABMS or AOA).
• Must possess an active unrestricted medical license to practice medicine or health profession.
• Must be located in the United States when conducting utilization review or appeals per policy.
• Minimum of 5 years of clinical experience or equivalent mix of education/experience.

Responsibilities

• Provide clinical guidance for pharmacy prior authorizations using CarelonRx guidelines.
• Support clinicians to ensure timely and consistent responses to members and providers.
• Conduct peer-to-peer prior authorization reviews with attending physicians or ordering providers to discuss determinations.
• Participate in a physician on-call weekend rotation for a 24x7 unit.

Education

MD or DO

Board certification (ABMS/AOA)

Unrestricted medical license

5+ years clinical experience

Job description

Location: 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. 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. Alternate locations may be considered.

CarelonRx delivers market-leading pharmacy benefit management and medication dispensing services to drive affordability and improve member outcomes.

The Medical Director Associate- CarelonRx supports pharmacy prior authorization reviews to ensure turnaround time is met and we are in compliance with all Pharmacy Benefit Management regulatory requirements.

How You Will Make An Impact

• May provide clinical guidance for pharmacy prior authorizations using CarelonRx clinical guidelines.
• Supports clinicians to ensure timely and consistent responses to members and providers.
• Conducts peer-to-peer prior authorization reviews for medications with attending physicians or other ordering providers to discuss review determinations.
• Will participate in a physician on-call weekend rotation for a 24x7 unit.

Minimum 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.

Preferred Qualifications

• Utilization management experience preferred.

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 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.