Remote Medical Director Associate — Prior Authorization

Elevance Health; Grand Prairie (TX); Hybrid; USD 180,000 - 230,000; Full time

Benefits offered by this job

Hybrid work model

Job summary

Elevance Health is seeking a Medical Director Associate for CarelonRx. This role supports pharmacy prior authorization reviews to ensure timely determinations and compliance with regulatory requirements.

The position involves collaborating with clinicians to provide consistent member/provider responses and participating in a physician on-call weekend rotation. Requires an MD or DO with board certification and an active medical license, plus at least five years of clinical experience.

Qualifications

• Requires MD or DO and board certification by ABMS or AOA.
• Must hold an active unrestricted medical license to practice medicine.
• Location must be within a US state; on-site/remote mix allowed with travel requirement.
• Minimum of 5 years of clinical experience or equivalent background.

Responsibilities

• Provide clinical guidance for pharmacy prior authorizations using CarelonRx guidelines.
• Support clinicians to deliver timely and consistent responses to members and providers.
• Conduct peer-to-peer prior authorization reviews with ordering providers to discuss determinations.
• Participate in a physician on-call weekend rotation for 24x7 coverage.

Skills

MD or DO

Active medical license

Board certification

5+ years clinical experience

Education

MD or DO degree

Job description

Elevance Health is seeking a Medical Director Associate for CarelonRx. This role supports pharmacy prior authorization reviews to ensure timely determinations and compliance with regulatory requirements.

The position involves collaborating with clinicians to provide consistent member/provider responses and participating in a physician on-call weekend rotation. Requires an MD or DO with board certification and an active medical license, plus at least five years of clinical experience.