Remote Medical Director, DMEPOS — Clinical Ops

Elevance Health; Nashville (TN); Hybrid; USD 180,000 - 230,000; Full time

Job summary

Elevance Health seeks a Clinical Operations Associate Medical Director - DMEPOS to support medical management staff, ensuring timely medical decisions for members and providers regarding DME.

The role conducts clinical case reviews, calls physicians to gather information, and makes medical necessity determinations for services, grievances, and appeals with policy consistency. This hybrid/virtual position includes in-person training.

Qualifications

• Requires MD/DO and board certification approved by ABMS or AOA.
• Active unrestricted medical license to practice medicine or health profession.
• Board certification in Family Medicine, Internal Medicine, or PM&R preferred.

Responsibilities

• Supports medical management staff in timely medical decisions for members and providers regarding DME.
• Ensures timely completion of clinical case reviews for their board certified specialty.
• Makes physician-to-physician calls to gather information for medical necessity determinations.
• Determines medical necessity for services, grievances and appeals, and enforces policy consistency.

Skills

MD/DO

Board certification

Active medical license

Education

MD/DO

Job description

Elevance Health seeks a Clinical Operations Associate Medical Director - DMEPOS to support medical management staff, ensuring timely medical decisions for members and providers regarding DME.

The role conducts clinical case reviews, calls physicians to gather information, and makes medical necessity determinations for services, grievances, and appeals with policy consistency. This hybrid/virtual position includes in-person training.