Remote Associate Medical Director - DMEPOS

elevancehealth; Nashville (TN); Remote; USD 180,000 - 240,000; Full time

Job summary

Elevance Health is seeking a Clinical Operations Associate Medical Director – DMEPOS to support medical management staff in delivering timely, medically sound determinations on DME requests. The role involves physician-to-physician communications, adherence to medical policies, and potential escalation for policy interpretation.

The position is primarily remote with in-person training as required; candidates should hold an MD/DO with ABMS/AOA board certification and an active unrestricted

Qualifications

• MD/DO and board certification approved by ABMS or AOA, active unrestricted medical license.

Responsibilities

• Support medical management staff to ensure timely and consistent medical decisions for DME.
• Complete clinical case reviews for the board-certified specialty in a timely manner.
• Make physician-to-physician calls to gather information for medical necessity determinations.
• Determine medical necessity for grievances and appeals according to policies.
• Escalate decisions requiring Medical Director review or policy interpretation to supervisors.

Education

MD/DO with ABMS/AOA board certification (active, unrestricted)

Job description

Elevance Health is seeking a Clinical Operations Associate Medical Director – DMEPOS to support medical management staff in delivering timely, medically sound determinations on DME requests. The role involves physician-to-physician communications, adherence to medical policies, and potential escalation for policy interpretation.

The position is primarily remote with in-person training as required; candidates should hold an MD/DO with ABMS/AOA board certification and an active unrestricted