Clinical Ops Medical Director

Location : Within 50 miles of any Elevance Health Pulse Point officeShift : Monday – Friday; 8.5-hour shifts between 7am – 7pm CT (later shift hours preferred)The Clinical Ops Medical Director opportunity is responsible for supporting the medical management staff ensuring timely and consistent medical decisions to members and providers.How you will make an impact : Ensures timely completion of clinical case reviews for their board certified specialty.Makes physician to physician calls to gather medically appropriate information in order to make medical necessity determinations for services requested.Makes medical necessity determinations for grievances and appeals appropriate for their specialty.Ensures consistent use of company medical policies when making medical necessity decisions.Brings to their supervisor's attention any case review decisions that require Medical Director review or policy interpretation.Minimum Requirements : Requires an MD and a 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.Preferred skills, capabilities, and experiences : This job is paid on an hourly basis.For candidates working in person or remotely in the below location(s), the salary

• range for this specific position is $206,995 to $324,594 ($99.52 to $156.06 hourly).Locations : Illinois; CaliforniaIn addition to your salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase, and 401k contributions (all benefits are subject to eligibility requirements).Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.Who We AreElevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.How We WorkAt Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes, and drive our shared success - for our consumers, our associates, our communities, and our business.Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient / member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state, and local laws.Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status, or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance.#J-18808-Ljbffr

Salary : $100 - $156