Medical Director Associate — Utilization Review

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

Job summary

Elevance Health is seeking a Medical Director Associate for CarelonRx to provide clinical guidance on prior authorisations and support timely decision-making for members and providers. This role includes peer-to-peer reviews and a physician on-call weekend rotation to ensure 24x7 coverage.

You will leverage CarelonRx guidelines, require an active medical license, and hold ABMS/AOA board certification with at least five years of clinical experience.

Qualifications

• MD or DO with ABMS/AOA board certification.
• Active unrestricted medical license to practice medicine.
• Minimum of 5 years of clinical experience.

Responsibilities

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

Skills

Clinical experience

Medical license

Board certification

Education

MD or DO

Job description

Elevance Health is seeking a Medical Director Associate for CarelonRx to provide clinical guidance on prior authorisations and support timely decision-making for members and providers. This role includes peer-to-peer reviews and a physician on-call weekend rotation to ensure 24x7 coverage.

You will leverage CarelonRx guidelines, require an active medical license, and hold ABMS/AOA board certification with at least five years of clinical experience.