Elevance Health
Medical Director Associate – CarelonRx
Anticipated End Date: 2025-12-05
Location This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work‑life integration, and ensures essential face‑to‑face onboarding and skill development. Candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.
CarelonRx delivers market‑leading pharmacy benefit management and medication dispensing services to drive affordability and improve member outcomes.
Job Description The Medical Director Associate – CarelonRx supports pharmacy prior authorization reviews to ensure turnaround time is met and we are in compliance with all Pharmacy Benefit Management regulatory requirements.
How you will make an impact
May provide clinical guidance for pharmacy prior authorizations using CarelonRx clinical guidelines.
Supports clinicians to ensure timely and consistent responses to members and providers.
Conducts peer‑to‑peer prior authorization reviews for medications with attending physicians or other ordering providers to discuss review determinations.
Will participate in a physician on‑call weekend rotation for a 24×7 unit.
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.
Unless expressly allowed by state or federal law, or regulation, must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US military base, vessel or any embassy located in or outside of the US.
Minimum of 5 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
Preferred Qualifications
Utilization management experience preferred.
Salary For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $224,784 to $369,288.
Locations District of Columbia (DC), Illinois, Massachusetts, Nevada.
Job Level Director Equivalent
Workshift 1st Shift (United States of America)
Job Family MED > Licensed Physician/Doctor/Dentist
Who We Are Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success – for our consumers, our associates, our communities and our business.
Benefits and Compensation In addition to your salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non‑discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.
Equal Employment Opportunity 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. 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, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
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Location This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work‑life integration, and ensures essential face‑to‑face onboarding and skill development. Candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.
CarelonRx delivers market‑leading pharmacy benefit management and medication dispensing services to drive affordability and improve member outcomes.
Job Description The Medical Director Associate – CarelonRx supports pharmacy prior authorization reviews to ensure turnaround time is met and we are in compliance with all Pharmacy Benefit Management regulatory requirements.
How you will make an impact
May provide clinical guidance for pharmacy prior authorizations using CarelonRx clinical guidelines.
Supports clinicians to ensure timely and consistent responses to members and providers.
Conducts peer‑to‑peer prior authorization reviews for medications with attending physicians or other ordering providers to discuss review determinations.
Will participate in a physician on‑call weekend rotation for a 24×7 unit.
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.
Unless expressly allowed by state or federal law, or regulation, must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US military base, vessel or any embassy located in or outside of the US.
Minimum of 5 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
Preferred Qualifications
Utilization management experience preferred.
Salary For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $224,784 to $369,288.
Locations District of Columbia (DC), Illinois, Massachusetts, Nevada.
Job Level Director Equivalent
Workshift 1st Shift (United States of America)
Job Family MED > Licensed Physician/Doctor/Dentist
Who We Are Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success – for our consumers, our associates, our communities and our business.
Benefits and Compensation In addition to your salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non‑discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.
Equal Employment Opportunity 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. 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, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
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