Medical Director - Post Acute Care

Elevance Health; Indianapolis (IN); Hybrid; USD 210,000 - 280,000; Full time

Benefits offered by this job

Sign-on bonus

Job summary

Carelon Medical Benefits Management seeks a Clinical Operations Medical Director to support medical management staff in timely, consistent medical decisions for members and providers. The role offers hybrid work with virtual capacity and requires occasional in-person training; weekend coverage occurs monthly.

A sign-on bonus of $10,000 is part of the package. Elevance Health’s Carelon group emphasizes whole-health care, collaboration, and patient-centered outcomes while offering competitive

Qualifications

• MD/DO with ABMS/AOA board certification.
• Active unrestricted medical license to practice medicine.
• Experience with clinical case reviews for medical necessity.

Responsibilities

• Ensure timely completion of clinical case reviews for their board certified specialty.
• Makes physician-to-physician calls to gather information for medical necessity determinations.
• Make medical necessity determinations for grievances and appeals.
• Ensure consistent use of medical policies in decisions; escalate when needed.

Skills

Medical decision making

Communication

Policy interpretation

Cross-functional collaboration

Education

MD/DO

Board certification (ABMS/AOA)

Tools

EMR systems

Job description

Post Acute Care Benefit Utilization Management

11:00AM-8:00PM CT. Will also require one weekend coverage shift a month.Part time options with at least one weekend day per week.

Alternate locations may be considered if candidates reside within a commuting distance from an office.

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.

Carelon, a proud member of the Elevance Health family of companies, is a healthcare services organization that takes a whole-health approach to making care more integrated, personalized, and affordable. We put people at the center—connecting physical, behavioral, social, and pharmacy services, along with clinical expertise, research, operations, and advanced technology to help care work better, together.
Among us are specialty-care physicians, nurse practitioners, pharmacists, engineers, data scientists, and other dedicated and caring health professionals. While our roles may differ, our purpose is shared: to make a positive impact on whole health.
The

Sign on bonus: $10, 000

Clinical Operations Medical Director

Carelon Medical Benefits Management

Post Acute Care Benefit Utilization Management

Schedule: 11:00AM-8:00PM CT. Will also require one weekend coverage shift a month.Part time options with at least one weekend day per week.

Virtual: 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 Alternate locations may be considered if candidates reside within a commuting distance from an office.

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.

Carelon, a proud member of the Elevance Health family of companies, is a healthcare services organization that takes a whole-health approach to making care more integrated, personalized, and affordable. We put people at the center—connecting physical, behavioral, social, and pharmacy services, along with clinical expertise, research, operations, and advanced technology to help care work better, together.
Among us are specialty-care physicians, nurse practitioners, pharmacists, engineers, data scientists, and other dedicated and caring health professionals. While our roles may differ, our purpose is shared: to make a positive impact on whole health.

The Clinical Operations Medical Director will be responsible for supporting the medical management staff ensuring timely and consistent medical decisions to members and providers.

How You Will Make An Impact

• Ensures timely completion of clinical case reviews for their board certified specialty.
• 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 company medical policies when making medical necessity decisions.
• Brings to their supervisors attention, any case review decisions that require Medical Director review or policy interpretation.
  

Minimum Requirements

• Requires MD/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.
• Minimum of 1 year of experience with clinical case reviews for medical necessity. The minimum of 1 year of experience with clinical case reviews would be waived for the following specific specialties only; Cardiology, Oncology, and Interventional Pain specialties.
• Board certification in a medical specialty required.

Preferred Skills, Capabilities And Experiences

• Board certified in Physical Medicine and Rehab is preferred.

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

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.