Medical Director Associate – CarelonRx

Elevance Health•Durham, NC

1d•Remote

About The Position

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. CarelonRx delivers market-leading pharmacy benefit management and medication dispensing services to drive affordability and improve member outcomes.

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.