Remote Medical Director Associate - Prior Authorization

Elevance Health (Anthem); Indianapolis (IN); Hybrid; USD 190,000 - 230,000; Full time

Job summary

Elevance Health is seeking a Medical Director Associate for CarelonRx to provide clinical guidance on pharmacy prior authorizations and ensure regulatory compliance. The role supports clinicians with timely responses to members and providers, and includes a physician on-call weekend rotation for a 24x7 unit.

Requires an MD or DO with board certification, an active unrestricted medical license, and at least five years of clinical experience.

Qualifications

• MD or DO with board certification as applicable to duties performed.
• Active unrestricted medical license to practice medicine or health professions.
• US residency requirement unless accommodation is granted by law or policy.
• Minimum of 5 years of clinical experience or equivalent education/experience.

Responsibilities

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

Skills

Clinical judgment

Team collaboration

Decision making

Education

MD/DO degree

Board certification (ABMS/AOA)

Job description

Elevance Health is seeking a Medical Director Associate for CarelonRx to provide clinical guidance on pharmacy prior authorizations and ensure regulatory compliance. The role supports clinicians with timely responses to members and providers, and includes a physician on-call weekend rotation for a 24x7 unit.

Requires an MD or DO with board certification, an active unrestricted medical license, and at least five years of clinical experience.