Elevance Health
Behavioral Health Medical Director - Psychiatrist Appeals
Elevance Health, Atlanta, Georgia, United States, 30383
Behavioral Health Medical Director - Psychiatrist Appeals
Elevance Health is seeking a Behavioral Health Medical Director – Psychiatrist Appeals to oversee behavioral health medical services, ensuring the appropriate and most cost‑effective care is received by members and providers. The role supports the development and implementation of programs to improve quality, cost, and outcomes and serves as a clinical/strategic advisor to enhance clinical operations.
Base pay range:
$274,068 – $428,976 per year.
Location and schedule: The role is primarily virtual with required in‑person training sessions; if you are within a reasonable commuting distance of the posting location(s), remote work is fully supported. Work schedule: Monday – Friday, with a half‑day Saturday rotation once a month.
Key responsibilities:
solares reinforce clinicians to ensure timely and consistent responses to members and providers.
provide guidance for clinical operational aspects of the program.
conduct peer‑to‑peer clinical appeal case reviews with attending physicians or other ordering providers.
serve as a resource and consultant to other areas of the company.
represent the company to external entities and serve on internal and external committees; may chair company committees.
interpret medical policies and clinical guidelines; develop and propose new policies based on healthcare changes.
lead, develop, direct, and implement clinical 蒜和 non‑clinical activities that impact health care quality, cost, and outcomes.
identify opportunities for innovation to increase effectiveness and quality.
provide oversight, direction, and guidance to Medical Director Associates.
work independently with oversight from the immediate manager.
may be responsible for an entire clinical program and/or independently perform clinical reviews.
typically have program management responsibilities including clinical policy development, quality, cost, and outcomes improvement, and oversight of clinical/non‑clinical activities.
Minimum qualifications:
MD or DO with board certification by an approved board (ABMS or AOA) relevant to duties.
Active, unrestricted medical license to practice medicine or a health profession.
Must be located in the United States (eligible for remote work within a reasonable commuting distance of the designated state).
Minimum 10 years of clinical experience (or equivalent combination of education and experience).
For Health Solutions and Carelon organizations (including Behavioral Health) only, minimum 5 years of experience providing health care.
Additional experience may be required by state contracts aivan regulatory obligations.
Preferred skills, capabilities and experiences:
Child and adolescent experience.
Utilization Management experience.
Applied Behavior Analysis (ABA) experience.
Active unrestricted medical license in California or ability to obtain upon hire.
Benefits:
Elevance Health offers a comprehensive benefits package, incentive and recognition programs, equity stock purchase, 401(k) contribution, and other benefits subject to eligibility requirements.
Equal Employment Opportunity statement:
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 applicable laws, including the Los AngelesConsult and California Fair Chance statutes.
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Base pay range:
$274,068 – $428,976 per year.
Location and schedule: The role is primarily virtual with required in‑person training sessions; if you are within a reasonable commuting distance of the posting location(s), remote work is fully supported. Work schedule: Monday – Friday, with a half‑day Saturday rotation once a month.
Key responsibilities:
solares reinforce clinicians to ensure timely and consistent responses to members and providers.
provide guidance for clinical operational aspects of the program.
conduct peer‑to‑peer clinical appeal case reviews with attending physicians or other ordering providers.
serve as a resource and consultant to other areas of the company.
represent the company to external entities and serve on internal and external committees; may chair company committees.
interpret medical policies and clinical guidelines; develop and propose new policies based on healthcare changes.
lead, develop, direct, and implement clinical 蒜和 non‑clinical activities that impact health care quality, cost, and outcomes.
identify opportunities for innovation to increase effectiveness and quality.
provide oversight, direction, and guidance to Medical Director Associates.
work independently with oversight from the immediate manager.
may be responsible for an entire clinical program and/or independently perform clinical reviews.
typically have program management responsibilities including clinical policy development, quality, cost, and outcomes improvement, and oversight of clinical/non‑clinical activities.
Minimum qualifications:
MD or DO with board certification by an approved board (ABMS or AOA) relevant to duties.
Active, unrestricted medical license to practice medicine or a health profession.
Must be located in the United States (eligible for remote work within a reasonable commuting distance of the designated state).
Minimum 10 years of clinical experience (or equivalent combination of education and experience).
For Health Solutions and Carelon organizations (including Behavioral Health) only, minimum 5 years of experience providing health care.
Additional experience may be required by state contracts aivan regulatory obligations.
Preferred skills, capabilities and experiences:
Child and adolescent experience.
Utilization Management experience.
Applied Behavior Analysis (ABA) experience.
Active unrestricted medical license in California or ability to obtain upon hire.
Benefits:
Elevance Health offers a comprehensive benefits package, incentive and recognition programs, equity stock purchase, 401(k) contribution, and other benefits subject to eligibility requirements.
Equal Employment Opportunity statement:
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 applicable laws, including the Los AngelesConsult and California Fair Chance statutes.
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