Elevance Health
Position Title:
Medical Director - Radiation Oncology Job Description: Clinical Operations Medical Director
for
Carelon Medical Benefit Management
in
Radiation Oncology . This 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 Medical Director
is responsible for supporting the medical management staff ensuring timely and consistent medical decisions to members and providers. Responsibilities: Ensures 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 company 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 Requirements: Requires MD or DO and Board certification approved by one of the following certifying boards is required, where applicable to duties being performed, American Board of Medical Specialties (ABMS) or American Osteopathic Association (AOA). Must possess an active unrestricted medical license to practice medicine or a health profession. Minimum of 1 year of experience with clinical case reviews for medical necessity. Preferred Skills, Capabilities, and Experiences Board certified in Radiation Oncology strongly preferred Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution. 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 (including gender identity and gender expression), 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.
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Medical Director - Radiation Oncology Job Description: Clinical Operations Medical Director
for
Carelon Medical Benefit Management
in
Radiation Oncology . This 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 Medical Director
is responsible for supporting the medical management staff ensuring timely and consistent medical decisions to members and providers. Responsibilities: Ensures 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 company 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 Requirements: Requires MD or DO and Board certification approved by one of the following certifying boards is required, where applicable to duties being performed, American Board of Medical Specialties (ABMS) or American Osteopathic Association (AOA). Must possess an active unrestricted medical license to practice medicine or a health profession. Minimum of 1 year of experience with clinical case reviews for medical necessity. Preferred Skills, Capabilities, and Experiences Board certified in Radiation Oncology strongly preferred Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution. 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 (including gender identity and gender expression), 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.
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