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Medical Oncology Medical Director

Elevance Health

Miami (FL)

Remote

USD 225,000 - 353,000

Full time

3 days ago

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Job summary

Elevance Health is seeking a Clinical Operations Medical Director for their Medical Oncology division. This virtual role offers the flexibility to manage clinical reviews, determine medical necessity, and support colleagues, all while maintaining compliance with policies and procedural regulations. Ideal candidates will possess an MD or DO along with board certifications in relevant specialties, contributing essential support within a leading medical benefit management organization.

Benefits

Comprehensive benefits package

Incentive and recognition programs

401k contribution

Qualifications

Must be board certified by a recognized certifying board.
Active unrestricted medical license required.
Minimum of 1 year experience with clinical case reviews.

Responsibilities

Conduct physician-level case reviews of medical oncology regimens.
Determine medical necessity following established guidelines.
Participate in physician meetings and assist peers with oncology utilization.

Skills

Oncology Knowledge

Clinical Case Review

Medical Necessity Determination

Peer-to-Peer Communication

Education

MD or DO

Board Certification in Medical Specialty

4 days ago Be among the first 25 applicants

Clinical Operations Medical Director Medical Oncology Carelon Medical Benefit Management 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. A proud member of the Elevance Health family of companies, Carelon Medical Benefits Management, formerly AIM Specialty Health, is a benefit-management leader in Illinois. Our platform delivers significant cost-of-care savings across an expanding set of clinical domains, including radiology, cardiology and oncology. The Clinical Operations Medical Director is responsible for supporting the medical management staff ensuring timely and consistent medical decisions to members and providers. How you will make an impact: Perform physician-level case review, following initial nurse review, of Medical Oncology regimens and supportive care. Perform physician-level case review, following initial nurse review, of chemotherapy regimens. Determine medical necessity of requests using guidelines and client-specific health plan medical policy. Conduct peer-to-peer discussions with ordering physicians, physician assistants, and nurse practitioners to provide education regarding established guidelines and accepted standards of oncology care. Document the pre-certification review in a complete, concise, and accurate manner in the pre-certification computer application. Demonstrate and maintain current knowledge of new cancer treatment regimens. As necessary, assist pre-certification nurses and other staff in understanding the principles behind appropriate utilization of covered treatments and genetic testing. Participate in periodic physician team meetings. Demonstrate and maintain knowledge of relevant policies and regulations pertaining to utilization review of oncology care. Participate on committees or in work groups as needed for revision of clinical guidelines and/or serve as a subject matter expert. Perform first level provider appeals as designated by the client for adverse determinations. Obtain additional state licensure based upon business needs. Adhere to all company protocols, policies, and procedures. 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. 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 Qualifications: Board Certification in Medical Oncology strongly preferred. 3-5 years of clinical practice experience past fellowship training is desirable. Demonstrated knowledge of current practice standards in oncology For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $225,039 to $352,236. Locations: California In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws. * The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.

Seniority level

Seniority level
Mid-Senior level

Employment type

Employment type
Full-time

Job function

Job function
Health Care Provider
Industries
Hospitals and Health Care

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