Medical Director - Post Acute Care

Elevance Health • Indianapolis, IN

1d • Remote

About The Position

The Clinical Operations Medical Director for Carelon Medical Benefits Management’s Post Acute Care Benefit Utilization Management supports medical management staff by ensuring timely and consistent medical decisions for members and providers. The role completes clinical case reviews within the physician’s board-certified specialty, conducts physician-to-physician calls to obtain information relevant to medical necessity determinations, and makes medical necessity determinations for appropriate grievances and appeals. Decisions must consistently apply company medical policies, and cases requiring Medical Director review or policy interpretation must be brought to supervisors’ attention.

The role is primarily virtual, with required in-person training sessions. Candidates must live within commuting distance of a posting location unless an accommodation is granted. The stated schedule is 11:00 a.m.–8:00 p.m. Central Time and includes one weekend coverage shift per month. Part-time options are available and require at least one weekend day per week. A $10,000 sign-on bonus is listed.

Requirements

• MD or DO degree.
• Board certification in a medical specialty; certification must be approved by ABMS or AOA where applicable to the duties performed.
• Active, unrestricted license to practice medicine or a health profession.
• At least 1 year of experience with clinical case reviews for medical necessity. This experience requirement is waived for Cardiology, Oncology, and Interventional Pain specialties.

Nice To Haves

• Board certification in Physical Medicine and Rehabilitation is preferred.

Responsibilities

• Complete clinical case reviews in the physician’s board-certified specialty in a timely manner.
• Conduct physician-to-physician calls to gather information needed to make medical necessity determinations for requested services.
• Make medical necessity determinations for grievances and appeals appropriate to the physician’s specialty.
• Apply company medical policies consistently when making medical necessity decisions.
• Bring cases requiring Medical Director review or policy interpretation to supervisors’ attention.

Benefits

• $10,000 sign-on bonus
• Merit increases
• Paid holidays
• Paid Time Off
• Incentive bonus programs, unless covered by a collective bargaining agreement
• Medical insurance
• Dental insurance
• Vision insurance
• Short- and long-term disability benefits
• 401(k) with company match
• Stock purchase plan
• Life insurance
• Wellness programs
• Financial education resources

What This Job Offers

• Job Type: Full-time
• Education Level: Ph.D. or professional degree