Remote Medical Director, PM&R — Utilization & Policy

Elevance Health, Inc.; Atlanta (GA); Hybrid; USD 190,000 - 270,000; Full time

Job summary

Elevance Health, Inc. seeks a Medical Director to lead clinical review processes within Home Care DME, interfacing with providers, members, and external physicians. The role focuses on evaluating case appropriateness, policy adherence, and program outcomes across several states.

You will mentor teams, develop medical policies, and support face-to-face onboarding during required training sessions. A strong background in utilization review and cross-state collaboration is essential.

Qualifications

• MD or DO with board certification by ABMS or AOA.
• Active unrestricted medical license required.
• Minimum 10 years of clinical experience (5 years for Health Solutions/Carelon contexts).

Responsibilities

• Support clinicians to ensure timely, consistent responses to members and providers.
• Provide guidance for clinical operational aspects of a program.
• Conduct peer-to-peer reviews with physicians to discuss determinations.
• Collaborate cross-functionally across distributed teams and states.
• Interpret medical policies and propose updates based on healthcare changes.

Skills

Clinical leadership

Utilization management

Policy interpretation

Education

MD or DO degree

Job description

Elevance Health, Inc. seeks a Medical Director to lead clinical review processes within Home Care DME, interfacing with providers, members, and external physicians. The role focuses on evaluating case appropriateness, policy adherence, and program outcomes across several states.

You will mentor teams, develop medical policies, and support face-to-face onboarding during required training sessions. A strong background in utilization review and cross-state collaboration is essential.