Remote Medical Director Associate - Prior Authorization & UM

Nexxt, Inc.; Wilmington (DE); Hybrid; USD 180,000 - 240,000; Full time

Job summary

Elevance Health is seeking a Medical Director Associate for CarelonRx to support pharmacy prior authorization reviews, ensuring regulatory compliance and timely determinations. This role offers virtual work with required in-person training and a policy about hybrid/remote work; candidates must be US-based.

The ideal candidate holds an MD/DO with board certification, an active unrestricted license, and at least five years of clinical experience; utilization management experience is preferred.

Qualifications

• Requires MD or DO and Board certification approved by ABMS or AOA.
• Must possess an active unrestricted medical license to practice medicine or a health profession.
• Must be located in the United States for utilization review or appeals, and cannot be located on a US military base, vessel or embassy.
• Minimum of 5 years of clinical experience; or any combination of education and experience providing an equivalent background.

Responsibilities

• May provide clinical guidance for pharmacy prior authorizations using CarelonRx guidelines.
• Supports clinicians to ensure timely and consistent responses to members and providers.
• Conducts peer-to-peer prior authorization reviews for medications with attending physicians or other ordering providers to discuss review determinations.
• Will participate in a physician on-call weekend rotation for a 24x7 unit.

Skills

MD/DO

Board certification

Active medical license

Utilization management (preferred)

Education

MD/DO degree

Board certification (ABMS/AOA)

Job description

Elevance Health is seeking a Medical Director Associate for CarelonRx to support pharmacy prior authorization reviews, ensuring regulatory compliance and timely determinations. This role offers virtual work with required in-person training and a policy about hybrid/remote work; candidates must be US-based.

The ideal candidate holds an MD/DO with board certification, an active unrestricted license, and at least five years of clinical experience; utilization management experience is preferred.