Medical Director - Post Acute Care
About The Position
The Clinical Operations Medical Director will be responsible for supporting the medical management staff ensuring timely and consistent medical decisions to members and providers. 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.
Requirements
- Requires MD/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.
- Minimum of 1 year of experience with clinical case reviews for medical necessity.
- The minimum of 1 year of experience with clinical case reviews would be waived for the following specific specialties only; Cardiology, Oncology, and Interventional Pain specialties.
- Board certification in a medical specialty required.
Nice To Haves
- Board certified in Physical Medicine and Rehab is preferred.
Responsibilities
- Ensures timely completion of clinical case reviews for their board certified specialty.
- Makes physician to physician calls to gather medical appropriate information in order to make medical necessity determinations for services requested.
- Makes medical necessity determinations for grievance and appeals appropriate for their specialty.
- Ensures consistent use of company medical policies when making medical necessity decisions.
- Brings to their supervisors attention, any case review decisions that require Medical Director review or policy interpretation.
Benefits
- merit increases
- paid holidays
- Paid Time Off
- incentive bonus programs
- medical
- dental
- vision
- short and long term disability benefits
- 401(k) +match
- stock purchase plan
- life insurance
- wellness programs
- financial education resources
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What This Job Offers
Job Type
Part-time
Career Level
Mid Level
Education Level
Ph.D. or professional degree
