Elevance Health
Associate Medical Director - Orthopedic Spine
Elevance Health, Walnut Creek, California, United States, 94598
Associate Medical Director - Orthopedic Spine
Clinical Operations Associate Medical Director – Orthopedic Spine Surgery at Carelon Medical Benefit Management. Schedule: 10:30 AM - 7 PM Central. Virtual: This role enables associates to work virtually full-time, with required in-person training sessions. This approach provides flexibility and onboarding opportunities.
Please note: per policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered unless an accommodation is granted as required by law.
What You Will Do
Perform pre-authorizations and provide quality improvement solutions for musculoskeletal procedures involving the spine and/or joints, and high-tech diagnostic imaging.
Determine medical necessity of requests using clinical criteria; perform physician-level case reviews of musculoskeletal utilization requests.
Conduct peer-to-peer consultations with ordering physicians, physician assistants and advanced practice nurses regarding guidelines and standards of care related to treatments, surgical procedures, imaging and sites of service.
Educate on applicable clinical criteria and discuss clinically appropriate alternative surgical and non-surgical treatments.
Perform first-level provider appeals of coverage decisions.
Provide support and education to internal clinical and non-clinical staff on musculoskeletal diagnoses, treatments, and management.
Participate in physician team meetings and in groups that develop or revise clinical appropriateness guidelines.
Minimum Requirements
MD or DO and Board certification by the American Board of Orthopedic Surgery or American Osteopathic Board of Orthopedic Surgery.
Current unrestricted medical license(s) as a Doctor of Medicine or Doctor of Osteopathic Medicine in appropriate state(s).
Experience performing standard neurosurgical spine procedures independently.
Preferred Skills, Capabilities And Experiences
Minimum of 3 years of clinical practice experience past fellowship training preferred.
Extensive spine surgery experience preferred.
Experience with utilization management, especially CMS guidelines preferred.
Orthopedic Spine Fellowship completion strongly preferred.
Location and Compensation Salary range for this position (in specific locations) is $247,382 to $424,095. Locations: California, New York.
Benefits and Workplace Elevance Health offers a comprehensive benefits package, incentive programs, 401(k) with company match, stock purchase plan, life insurance, and wellness resources. Elevance Health operates a Hybrid Workforce Strategy; time onsite requirements will be discussed during hiring. COVID-19 and Influenza vaccination requirements apply where mandated by law.
Equal Opportunity Elevance Health is an Equal Employment Opportunity employer. Qualified applicants will receive consideration 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 protected by law. Accommodations for the application process may be requested at elevancehealthjobssupport@elevancehealth.com. Qualified applicants with arrest or conviction records will be considered in accordance with applicable laws.
Company Overview Elevance Health is a health company dedicated to improving lives and communities. We are a Fortune 25 company with a history in healthcare, focused on leadership and impact for our members and communities we serve.
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Please note: per policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered unless an accommodation is granted as required by law.
What You Will Do
Perform pre-authorizations and provide quality improvement solutions for musculoskeletal procedures involving the spine and/or joints, and high-tech diagnostic imaging.
Determine medical necessity of requests using clinical criteria; perform physician-level case reviews of musculoskeletal utilization requests.
Conduct peer-to-peer consultations with ordering physicians, physician assistants and advanced practice nurses regarding guidelines and standards of care related to treatments, surgical procedures, imaging and sites of service.
Educate on applicable clinical criteria and discuss clinically appropriate alternative surgical and non-surgical treatments.
Perform first-level provider appeals of coverage decisions.
Provide support and education to internal clinical and non-clinical staff on musculoskeletal diagnoses, treatments, and management.
Participate in physician team meetings and in groups that develop or revise clinical appropriateness guidelines.
Minimum Requirements
MD or DO and Board certification by the American Board of Orthopedic Surgery or American Osteopathic Board of Orthopedic Surgery.
Current unrestricted medical license(s) as a Doctor of Medicine or Doctor of Osteopathic Medicine in appropriate state(s).
Experience performing standard neurosurgical spine procedures independently.
Preferred Skills, Capabilities And Experiences
Minimum of 3 years of clinical practice experience past fellowship training preferred.
Extensive spine surgery experience preferred.
Experience with utilization management, especially CMS guidelines preferred.
Orthopedic Spine Fellowship completion strongly preferred.
Location and Compensation Salary range for this position (in specific locations) is $247,382 to $424,095. Locations: California, New York.
Benefits and Workplace Elevance Health offers a comprehensive benefits package, incentive programs, 401(k) with company match, stock purchase plan, life insurance, and wellness resources. Elevance Health operates a Hybrid Workforce Strategy; time onsite requirements will be discussed during hiring. COVID-19 and Influenza vaccination requirements apply where mandated by law.
Equal Opportunity Elevance Health is an Equal Employment Opportunity employer. Qualified applicants will receive consideration 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 protected by law. Accommodations for the application process may be requested at elevancehealthjobssupport@elevancehealth.com. Qualified applicants with arrest or conviction records will be considered in accordance with applicable laws.
Company Overview Elevance Health is a health company dedicated to improving lives and communities. We are a Fortune 25 company with a history in healthcare, focused on leadership and impact for our members and communities we serve.
#J-18808-Ljbffr