Medical Director Associate – CarelonRx
About The Position
Medical Director Associate – CarelonRx 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. 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. Alternate locations may be considered. CarelonRx delivers market-leading pharmacy benefit management and medication dispensing services to drive affordability and improve member outcomes. 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 24x7 unit.
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.
Nice To Haves
- Utilization management experience preferred.
Responsibilities
- 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 24x7 unit.
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).
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What This Job Offers
Job Type
Full-time
Career Level
Director
Education Level
Ph.D. or professional degree
