Medical Director, Post-Acute Care Utilization (Hybrid)

Elevance Health; Indianapolis (IN); Remote; USD 180,000 - 280,000; Full time

Benefits offered by this job

Sign-on bonus $10,000

Job summary

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.

Qualifications

• 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.

Responsibilities

• 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.

Education

MD/DO

Board certification (ABMS or AOA)

Active unrestricted medical license

Clinical case reviews

Medical necessity determinations

Policy interpretation

Job description

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.