Elevance Health
Overview
Medical Director- Commercial Location: This role allows virtual, full-time work with required in-person training sessions for onboarding and skill development. Hybrid/virtual work policy applies; candidates must be within a reasonable commuting distance from the posting location unless an accommodation is granted by law. Preference for candidates residing in CO, OH, IN, KY, MO, and WI. Schedule:
Monday through Friday 8am-5pm CST or EST. If located in Colorado, MST is acceptable. Weekend rotation coverage required 5-6 weekends per year. Role and Scope
The Medical Director will be part of the Central Region team responsible for utilization review case management and appeals for local Commercial business in CO, OH, IN, KY, MO, and WI markets. Responsibilities may include developing and implementing programs to improve quality, cost, and outcomes; providing clinical consultation and serving as a clinical/strategic advisor to enhance clinical operations; identifying cost of care opportunities; and serving as a resource to staff including Medical Director Associates. How you will make an impact
Supports clinicians to ensure timely and consistent responses to members and providers. Provides guidance for clinical operational aspects of a program. Conducts peer-to-peer clinical reviews with attending physicians or other providers to discuss review determinations and patients’ office visits with providers and external physicians. Reviews may include peer-to-peer clinical appeal case reviews with attending physicians or other ordering providers to discuss review determinations. Serves as a resource and consultant to other areas of the company. May represent the company to external entities and/or serve on internal and/or external committees. May chair company committees. Interprets medical policies and clinical guidelines. May develop and propose new medical policies based on changes in healthcare. Leads, develops, directs, and implements clinical and non-clinical activities that impact health care quality, cost, and outcomes. Identifies and develops opportunities for innovation to increase effectiveness and quality. Minimum Requirements
MD or DO with Board certification approved by ABMS or AOA, where applicable to duties performed. Active unrestricted medical license to practice medicine or a health profession. Must be located in a U.S. state or territory when conducting utilization review or an appeals consideration, unless prohibited by state or federal law; cannot be located on a U.S. military base, vessel, or embassy. Minimum of 10 years of clinical experience; or any combination of education and experience providing an equivalent background. For Health Solutions and Carelon organizations (including behavioral health), a minimum of 5 years of health care experience is required. Additional state contract or regulatory requirements may apply for State-specific roles. Preferred Qualifications
General Surgeon or Primary Care specialties preferred. Compensation and Benefits
For candidates working in person or virtually in the listed location(s), the salary range for this position is $262,152 to $393,228. The salary is based on various factors including location, experience, education, and skill level. Elevance Health offers a comprehensive benefits package including incentive programs, equity, 401(k) contributions, medical, dental, vision, disability, life insurance, wellness programs, and financial education resources. Benefits are subject to eligibility requirements. Elevance Health operates a Hybrid Workforce Strategy. Associates may be required to work at an Elevance Health location at least once per week, with specifics discussed during the hiring process. Important Notices
The health of our associates and communities is a priority. New candidates in certain patient/member-facing roles may be required to be vaccinated against COVID-19 and Influenza, per policy and applicable laws. Elevance Health is an Equal Employment Opportunity employer. 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 protected by law. Reasonable accommodation is available for applicants during the hiring process. Applicants with arrest or conviction records will be considered in accordance with applicable laws.
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Medical Director- Commercial Location: This role allows virtual, full-time work with required in-person training sessions for onboarding and skill development. Hybrid/virtual work policy applies; candidates must be within a reasonable commuting distance from the posting location unless an accommodation is granted by law. Preference for candidates residing in CO, OH, IN, KY, MO, and WI. Schedule:
Monday through Friday 8am-5pm CST or EST. If located in Colorado, MST is acceptable. Weekend rotation coverage required 5-6 weekends per year. Role and Scope
The Medical Director will be part of the Central Region team responsible for utilization review case management and appeals for local Commercial business in CO, OH, IN, KY, MO, and WI markets. Responsibilities may include developing and implementing programs to improve quality, cost, and outcomes; providing clinical consultation and serving as a clinical/strategic advisor to enhance clinical operations; identifying cost of care opportunities; and serving as a resource to staff including Medical Director Associates. How you will make an impact
Supports clinicians to ensure timely and consistent responses to members and providers. Provides guidance for clinical operational aspects of a program. Conducts peer-to-peer clinical reviews with attending physicians or other providers to discuss review determinations and patients’ office visits with providers and external physicians. Reviews may include peer-to-peer clinical appeal case reviews with attending physicians or other ordering providers to discuss review determinations. Serves as a resource and consultant to other areas of the company. May represent the company to external entities and/or serve on internal and/or external committees. May chair company committees. Interprets medical policies and clinical guidelines. May develop and propose new medical policies based on changes in healthcare. Leads, develops, directs, and implements clinical and non-clinical activities that impact health care quality, cost, and outcomes. Identifies and develops opportunities for innovation to increase effectiveness and quality. Minimum Requirements
MD or DO with Board certification approved by ABMS or AOA, where applicable to duties performed. Active unrestricted medical license to practice medicine or a health profession. Must be located in a U.S. state or territory when conducting utilization review or an appeals consideration, unless prohibited by state or federal law; cannot be located on a U.S. military base, vessel, or embassy. Minimum of 10 years of clinical experience; or any combination of education and experience providing an equivalent background. For Health Solutions and Carelon organizations (including behavioral health), a minimum of 5 years of health care experience is required. Additional state contract or regulatory requirements may apply for State-specific roles. Preferred Qualifications
General Surgeon or Primary Care specialties preferred. Compensation and Benefits
For candidates working in person or virtually in the listed location(s), the salary range for this position is $262,152 to $393,228. The salary is based on various factors including location, experience, education, and skill level. Elevance Health offers a comprehensive benefits package including incentive programs, equity, 401(k) contributions, medical, dental, vision, disability, life insurance, wellness programs, and financial education resources. Benefits are subject to eligibility requirements. Elevance Health operates a Hybrid Workforce Strategy. Associates may be required to work at an Elevance Health location at least once per week, with specifics discussed during the hiring process. Important Notices
The health of our associates and communities is a priority. New candidates in certain patient/member-facing roles may be required to be vaccinated against COVID-19 and Influenza, per policy and applicable laws. Elevance Health is an Equal Employment Opportunity employer. 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 protected by law. Reasonable accommodation is available for applicants during the hiring process. Applicants with arrest or conviction records will be considered in accordance with applicable laws.
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