Elevance Health
Behavioral Health Medical Director - Psychiatrist Appeals
Elevance Health, Tampa, Florida, us, 33646
Behavioral Health Medical Director - Psychiatrist Appeals
Join to apply for the
Behavioral Health Medical Director - Psychiatrist Appeals
role at
Elevance Health .
This range is provided by Elevance Health. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more.
Base pay range $274,068.00/yr - $428,976.00/yr
Location & Work schedule This role enables associates to work virtually full‑time, with the exception of required in‑person training sessions, providing maximum flexibility and autonomy. Alternate locations can be considered. 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.
Work schedule: Monday - Friday. Half day Saturday rotation, once a month.
Responsibilities
Supports clinicians to ensure timely and consistent responses to members and providers.
Provides guidance for clinical operational aspects of a program.
Conduct 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 be required to 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.
Provides oversight, direction, and guidance to Medical Director Associates.
Works independently with oversight from immediate manager.
May be responsible for an entire clinical program and/or independently performs clinical reviews.
Typically has program management responsibilities including clinical policy development, improvement of quality, cost and outcomes, program development/implementation, and overseeing clinical/non‑clinical activities.
Minimum Qualifications
MD or DO and Board certification approved by one of the following certifying boards is required wherever applicable: 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, 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 10 years of clinical experience; or any combination of education and experience equivalent to that requirement.
For Health Solutions and Carelon organizations (including Behavioral Health) only, minimum of 5 years of experience providing health care is required.
Additional experience may be required by State contracts or regulations if the Medical Director is filing a role required by a State agency.
Preferred Skills, Capabilities And Experiences
Child and Adolescent experience preferred.
Utilization Management experience.
Applied Behavior Analysis (ABA) experience.
An active unrestricted medical license to practice medicine or a health profession in California or ability to obtain upon hire.
Salary For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $274,068 to $428,976.
Locations: Costa Mesa, CA, Walnut Creek, CA, Woodland Hills, CA
Benefits In addition to your salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401(k) 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.
The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law.
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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Behavioral Health Medical Director - Psychiatrist Appeals
role at
Elevance Health .
This range is provided by Elevance Health. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more.
Base pay range $274,068.00/yr - $428,976.00/yr
Location & Work schedule This role enables associates to work virtually full‑time, with the exception of required in‑person training sessions, providing maximum flexibility and autonomy. Alternate locations can be considered. 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.
Work schedule: Monday - Friday. Half day Saturday rotation, once a month.
Responsibilities
Supports clinicians to ensure timely and consistent responses to members and providers.
Provides guidance for clinical operational aspects of a program.
Conduct 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 be required to 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.
Provides oversight, direction, and guidance to Medical Director Associates.
Works independently with oversight from immediate manager.
May be responsible for an entire clinical program and/or independently performs clinical reviews.
Typically has program management responsibilities including clinical policy development, improvement of quality, cost and outcomes, program development/implementation, and overseeing clinical/non‑clinical activities.
Minimum Qualifications
MD or DO and Board certification approved by one of the following certifying boards is required wherever applicable: 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, 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 10 years of clinical experience; or any combination of education and experience equivalent to that requirement.
For Health Solutions and Carelon organizations (including Behavioral Health) only, minimum of 5 years of experience providing health care is required.
Additional experience may be required by State contracts or regulations if the Medical Director is filing a role required by a State agency.
Preferred Skills, Capabilities And Experiences
Child and Adolescent experience preferred.
Utilization Management experience.
Applied Behavior Analysis (ABA) experience.
An active unrestricted medical license to practice medicine or a health profession in California or ability to obtain upon hire.
Salary For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $274,068 to $428,976.
Locations: Costa Mesa, CA, Walnut Creek, CA, Woodland Hills, CA
Benefits In addition to your salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401(k) 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.
The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law.
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.
#J-18808-Ljbffr