Job Description
Clinical Operations Associate Medical DirectorCarelon Medical Benefits ManagementThis role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy.The Clinical Operations Associate Medical Director is responsible for supporting the medical management staff, ensuring timely and consistent medical decisions for members and providers.How you will make an impactEnsures timely completion of clinical case reviews for their board-certified specialty.Makes physician-to-physician calls to gather medical-appropriate information in order to make medical necessity determinations for services requested.Makes medical necessity determinations for grievance and appeals appropriate for their specialty.Ensures consistent use of medical policies when making medical necessity decisions.Brings to their supervisors attention any case-review decisions that require Medical Director review or policy interpretation.Minimum RequirementsMD or DO with board certification approved by one of the following certifying boards: American Board of Medical Specialties (ABMS) or American Osteopathic Association (AOA).Active unrestricted medical license to practice medicine or a health profession.Preferred Skills, Capabilities and ExperiencesBoard Certification in Sleep Medicine from the American Board of Medical Specialties is strongly preferred.3-5 years of clinical practice experience beyond fellowship training.For candidates working in person or virtually in the below location(s), the salary range for this specific position is $179,503 to $307,732.Locations: California, Illinois, Maryland, New YorkIn addition to your salary, Elevance Health offers a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements).Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender, marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance.Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 Florida Agency for Health Care Administration.