Elevance Health
Overview
Medical Director - Cardiology role at Elevance Health. Virtual option available with required in-person training sessions. Elevance Health operates with a hybrid workforce strategy and seeks leaders dedicated to improving member and provider outcomes. Carelon MBM
– Clinical Operations Medical Director – Carelon MBM – Virtual. Responsibilities
Support medical management staff to ensure timely and consistent medical decisions for members and providers. Participate in pre-authorization and quality improvement solutions for specialized cardiology and vascular surgery, including procedures such as coronary angiography, PCI, implanted cardiac devices, electrophysiology procedures, and arterial/venous endovascular interventions. Ensure timely completion of clinical case reviews for board-certified specialties. Make physician-to-physician calls to gather medical information for medical necessity determinations. Determine medical necessity for services, grievances, and appeals using applicable clinical criteria and guidelines (e.g., AIM Appropriateness Guidelines, medical policies, CMS determinations). Perform physician-level case reviews of utilization requests. Conduct peer-to-peer consultations with ordering physicians, PAs, and NPs regarding guidelines and standards of care related to treatments, procedures, imaging, and sites of service. Discuss clinically appropriate alternative treatments, imaging, and sites of care when consistent with clinical criteria. Provide education regarding applicable clinical criteria. Minimum Requirements
MD or DO with board certification approved by ABMS or AOA where applicable to duties. Active unrestricted medical license to practice medicine. Minimum of 1 year of experience with clinical case reviews for medical necessity (waived for Cardiology, Oncology, or Interventional Pain specialties). Board certification in a medical specialty. Preferred Skills, Capabilities, and Experiences
Board Certification in Cardiovascular Disease, Interventional Radiology, or Vascular Surgery by ABIM or equivalent. 3–5 years of clinical practice after fellowship is desirable. Knowledge of current practice standards in Vascular Surgery or Cardiology. Location and Compensation
Locations: District of Columbia (Washington, DC), Illinois, New York. Salary range for this position is $215,255 - $352,236 and may vary by geographic location, experience, education, and skill. Benefits and Workplace
Elevance Health offers comprehensive benefits, incentive programs, equity stock purchase, 401(k) matching, and other rewards. Hybrid work expectations apply unless specified as primarily virtual by the hiring manager. Vaccination requirements may apply for patient/member-facing roles in accordance with laws. Equal Opportunity
Elevance Health is an Equal Employment Opportunity employer. Qualified applicants will be considered without regard to age, citizenship status, color, creed, disability, ethnicity, gender, marital status, national origin, race, religion, sex, sexual orientation, veteran status, or other protected status. Accommodation inquiries: elevancehealthjobssupport@elevancehealth.com. Background check and fair chance considerations apply where required by law. Seniority level: Director • Employment type: Full-time • Job function: Health Care Provider • Industries: Hospitals and Health Care Note: This description retains the substantive job information from the original posting while improving structure and readability. Some extraneous postings and repetitive lines have been removed to focus on responsibilities, requirements, and key info.
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Medical Director - Cardiology role at Elevance Health. Virtual option available with required in-person training sessions. Elevance Health operates with a hybrid workforce strategy and seeks leaders dedicated to improving member and provider outcomes. Carelon MBM
– Clinical Operations Medical Director – Carelon MBM – Virtual. Responsibilities
Support medical management staff to ensure timely and consistent medical decisions for members and providers. Participate in pre-authorization and quality improvement solutions for specialized cardiology and vascular surgery, including procedures such as coronary angiography, PCI, implanted cardiac devices, electrophysiology procedures, and arterial/venous endovascular interventions. Ensure timely completion of clinical case reviews for board-certified specialties. Make physician-to-physician calls to gather medical information for medical necessity determinations. Determine medical necessity for services, grievances, and appeals using applicable clinical criteria and guidelines (e.g., AIM Appropriateness Guidelines, medical policies, CMS determinations). Perform physician-level case reviews of utilization requests. Conduct peer-to-peer consultations with ordering physicians, PAs, and NPs regarding guidelines and standards of care related to treatments, procedures, imaging, and sites of service. Discuss clinically appropriate alternative treatments, imaging, and sites of care when consistent with clinical criteria. Provide education regarding applicable clinical criteria. Minimum Requirements
MD or DO with board certification approved by ABMS or AOA where applicable to duties. Active unrestricted medical license to practice medicine. Minimum of 1 year of experience with clinical case reviews for medical necessity (waived for Cardiology, Oncology, or Interventional Pain specialties). Board certification in a medical specialty. Preferred Skills, Capabilities, and Experiences
Board Certification in Cardiovascular Disease, Interventional Radiology, or Vascular Surgery by ABIM or equivalent. 3–5 years of clinical practice after fellowship is desirable. Knowledge of current practice standards in Vascular Surgery or Cardiology. Location and Compensation
Locations: District of Columbia (Washington, DC), Illinois, New York. Salary range for this position is $215,255 - $352,236 and may vary by geographic location, experience, education, and skill. Benefits and Workplace
Elevance Health offers comprehensive benefits, incentive programs, equity stock purchase, 401(k) matching, and other rewards. Hybrid work expectations apply unless specified as primarily virtual by the hiring manager. Vaccination requirements may apply for patient/member-facing roles in accordance with laws. Equal Opportunity
Elevance Health is an Equal Employment Opportunity employer. Qualified applicants will be considered without regard to age, citizenship status, color, creed, disability, ethnicity, gender, marital status, national origin, race, religion, sex, sexual orientation, veteran status, or other protected status. Accommodation inquiries: elevancehealthjobssupport@elevancehealth.com. Background check and fair chance considerations apply where required by law. Seniority level: Director • Employment type: Full-time • Job function: Health Care Provider • Industries: Hospitals and Health Care Note: This description retains the substantive job information from the original posting while improving structure and readability. Some extraneous postings and repetitive lines have been removed to focus on responsibilities, requirements, and key info.
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