Remote Medical Director – Florida Medicare (UM/Policy)

Elevance Health, Inc.; Florida; Hybride; USD 138 000 - 248 000; Temps partiel

Résumé du poste

Elevance Health is seeking a Medical Director for Florida Medicare on a part-time basis. The role supports utilization management and medical necessity reviews for inpatient and outpatient care, with weekend on-call rotations as part of UM requirements.

The position offers virtual work with mandatory in-person training sessions and prefers candidates living near Florida. Ideal candidates hold an MD or DO with ABMS/AOA board certification and an active Florida medical license.

Qualifications

• MD/DO with ABMS or AOA board certification.
• Active Florida medical license required.
• Must be located in the United States, preferably Florida.
• Minimum of 10 years of clinical experience.
• For Health Solutions and Carelon: minimum 5 years of health care experience.
• Medicare experience preferred.
• Internal/Family Medicine or adult medicine training preferred.

Responsabilités

• Perform utilization management reviews to determine medical necessity and appropriateness of care.
• Review inpatient and outpatient authorizations and appeals.
• Lead and participate in committee work (peer review, credentialing, quality).
• Engage in cost of care initiatives and lead projects.
• Provide peer-to-peer discussions with treating physicians on medical decisions.
• Ensure reviews meet state/federal regulations and company standards.
• Represent the company to external entities when required.
• Develop and propose new medical policies as healthcare evolves.
• Lead clinical and non-clinical activities to improve health outcomes.
• Support continuity of UM operations with weekend coverage.

Connaissances

MD/DO

Board certification

Medical license (FL)

Clinical experience 10+ years

Medicare experience (preferred)

Health care operations knowledge

On-call/weekend readiness

Policy/compliance awareness

Formation

MD/DO degree

Board certification

Description du poste

Elevance Health is seeking a Medical Director for Florida Medicare on a part-time basis. The role supports utilization management and medical necessity reviews for inpatient and outpatient care, with weekend on-call rotations as part of UM requirements.

The position offers virtual work with mandatory in-person training sessions and prefers candidates living near Florida. Ideal candidates hold an MD or DO with ABMS/AOA board certification and an active Florida medical license.