Medicare Medical Director – Florida UM & Policy

Elevance Health; Miami (FL); Hybrid; USD 180,000 - 260,000; Full time

Benefits offered by this job

Health benefits

401(k) + match

Stock purchase plan

Paid time off

Job summary

Elevance Health is seeking a Medical Director for Florida Medicare to oversee utilization management, medical necessity reviews, and related committees. The role emphasizes collaboration with clinicians and cross-functional teams, with weekend rotations to support UM operations.

The position requires an active Florida medical license, extensive clinical experience, and ABMS/AOA board certification. A hybrid/virtual work model with in-person training is expected; occasional travel may be required.

Qualifications

• MD/DO with ABMS or AOA board certification.
• Active medical license in Florida.
• Minimum 10 years of clinical experience; health care experience may be required by State contracts.

Responsibilities

• Perform utilization management reviews to determine medical necessity and appropriateness of care.
• Review inpatient and outpatient authorizations and appeals for medical necessity.
• Lead peer-to-peer discussions with treating physicians on medical decisions.
• Collaborate with UM nurses and case managers on admissions and continued stays.
• Represent the company with external entities and participate in internal committees.
• Interpret medical policies and clinical guidelines; lead policy development.

Skills

Utilization management

Clinical collaboration

Peer-to-peer discussions

Policy interpretation

Education

MD/DO

ABMS/AOA board certification

Job description

Elevance Health is seeking a Medical Director for Florida Medicare to oversee utilization management, medical necessity reviews, and related committees. The role emphasizes collaboration with clinicians and cross-functional teams, with weekend rotations to support UM operations.

The position requires an active Florida medical license, extensive clinical experience, and ABMS/AOA board certification. A hybrid/virtual work model with in-person training is expected; occasional travel may be required.