Medical Director - Post Acute Care

Elevance Health; Indianapolis (IN); Remoto; USD 180.000 - 280.000; Tempo pieno

Vantaggi offerti da questo lavoro

Sign-on bonus $10,000

Descrizione del lavoro

Carelon Medical Benefits Management, part of Elevance Health, seeks a Clinical Operations Medical Director to manage medical necessity reviews for a board-certified specialty. The role includes physician-to-physician calls to collect information, and decisions aligned with policies.

Remote/alternate locations considered; weekend/onsite training may be required. Expect a strong emphasis on policy interpretation, medical policy consistency, and collaboration with supervisors on complex cases.

Competenze

• MD/DO with applicable board certification.
• Active unrestricted medical license to practice medicine.
• Minimum 1 year of clinical case reviews experience; waiver for Cardiology, Oncology, Interventional Pain.
• Board certification in a medical specialty is required.

Mansioni

• Ensures timely completion of clinical case reviews for their board certified specialty.
• Makes physician-to-physician calls to gather medical information for medical necessity determinations.
• Makes medical necessity determinations for grievance and appeals within their specialty.
• Ensures consistent use of company medical policies when making medical necessity decisions.
• Alerts supervisors to cases needing Medical Director review or policy interpretation.

Formazione

MD/DO

Board certification (ABMS or AOA)

Active unrestricted medical license

Clinical case reviews

Medical necessity determinations

Policy interpretation

Descrizione del lavoro

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.

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. 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.

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.