Medical Director - Radiation Oncology

Elevance Health; New York (NY); Remote; USD 100,000 - 125,000; Full time

Job summary

A leading healthcare organization is seeking a Medical Director for Radiation Oncology. This role involves overseeing clinical case reviews, supporting medical management staff, and ensuring adherence to medical policies. Candidates must hold an MD or DO, possess an active medical license, and have experience in clinical case reviews. This position offers virtual flexibility with necessary in-person training.

Benefits

Comprehensive benefits package

Incentive and recognition programs

Equity stock purchase

401k contribution

Qualifications

• Requires MD or DO and appropriate board certification.
• Active unrestricted medical license is a must.
• At least 1 year of experience in clinical case reviews.

Responsibilities

• Ensure timely completion of clinical case reviews.
• Make medical necessity determinations for services.
• Support medical management staff in decision-making.

Skills

Clinical case reviews

Medical necessity determinations

Communication with medical professionals

Education

MD or DO

Board certification in relevant specialty

Job description

Position Title: Medical Director - Radiation Oncology

Job Description:

Clinical Operations Medical Director for Carelon Medical Benefit Management in Radiation Oncology.

This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy.

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

Responsibilities:

• 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 or 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.

Preferred Skills, Capabilities, and Experiences

• Board certified in Radiation Oncology strongly preferred

Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution.

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.