Medical Director Associate: Clinical Reviews & Policy

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

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.