Associate Medical Director- Orthopedic Spine Surgery
About The Position
Clinical Operations Associate Medical Director Carelon Medical Benefits Management Orthopedic Spine Surgery Virtual: 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. Please note that per our policy on hybrid/virtual work, 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. Carelon, a proud member of the Elevance Health family of companies, is a healthcare services organization that takes a whole-health approach to making care more integrated, personalized, and affordable. We put people at the center—connecting physical, behavioral, social, and pharmacy services, along with clinical expertise, research, operations, and advanced technology to help care work better, together. Among us are specialty-care physicians, nurse practitioners, pharmacists, engineers, data scientists, and other dedicated and caring health professionals. While our roles may differ, our purpose is shared: to make a positive impact on whole health. The Clinical Operations Associate Medical Director is responsible for performing pre-authorizations and providing quality improvement solutions for musculoskeletal procedures involving the spine and/or joints, and high-tech diagnostic imaging.
Requirements
- Requires MD/DO and Board certification by the American Board of Neurologic Surgery or American Osteopathic Board of Neurosurgery.
- Additionally, American Board of Orthopedic Surgery with completion of fellowship training in Spine Surgery or American Osteopathic Board of Orthopedic Surgery with completion of fellowship training in Spine Surgery also meets the Board certification requirements for this position.
- Current unrestricted medical license(s) as a Doctor of Medicine or Doctor of Osteopathic Medicine in appropriate state(s) required.
- Experience performing standard neurosurgical spine procedures independently.
Nice To Haves
- Minimum of 3 years of clinical practice experience past fellowship training preferred.
- Extensive spine surgery experience preferred.
- Experience with utilization management, especially with CMS guidelines preferred.
Responsibilities
- Determines the medical necessity of requests using clinical criteria.
- Performs physician-level case review of musculoskeletal utilization requests.
- Conducts peer-to-peer consultation with ordering physicians, physician assistants and advanced practice nurses regarding established guidelines and accepted standards of care as it relates to treatments, surgical procedures, imaging and appropriate sites of service.
- Provides education regarding applicable clinical criteria and discusses clinically appropriate alternative surgical and non-surgical treatments.
- Performs first level provider appeals of coverage decisions.
- Provides support and education to internal clinical and non-clinical staff regarding the principles associated with appropriate musculoskeletal diagnoses, treatments, and management.
- Participates in physician team meetings.
- Participates in groups that develop, revise and enhance clinical appropriateness guidelines.
Benefits
- 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).
- We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Ph.D. or professional degree
