Remote Medical Director Associate - Prior Authorization

Elevance Health; Indianapolis (IN); Hybrid; USD 180,000 - 240,000; Full time

Job summary

Elevance Health is seeking a Medical Director Associate for CarelonRx to lead pharmacy prior authorization reviews and ensure regulatory compliance. The role supports clinicians to provide timely responses to members and providers, with peer-to-peer discussions and an on-call weekend rotation for a 24x7 unit.

Qualified candidates hold an MD or DO with ABMS/AOA board certification, an active unrestricted medical license, and at least 5 years of clinical experience.

Qualifications

• MD or DO required with board certification (ABMS or AOA).
• Must possess an active unrestricted medical license to practice medicine or health profession.
• Must be located in the United States when conducting utilization review or appeals per policy.
• Minimum of 5 years of clinical experience or equivalent mix of 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 attending physicians or ordering providers to discuss determinations.
• Participate in a physician on-call weekend rotation for a 24x7 unit.

Education

MD or DO

Board certification (ABMS/AOA)

Unrestricted medical license

5+ years clinical experience

Job description

Elevance Health is seeking a Medical Director Associate for CarelonRx to lead pharmacy prior authorization reviews and ensure regulatory compliance. The role supports clinicians to provide timely responses to members and providers, with peer-to-peer discussions and an on-call weekend rotation for a 24x7 unit.

Qualified candidates hold an MD or DO with ABMS/AOA board certification, an active unrestricted medical license, and at least 5 years of clinical experience.