What are the responsibilities and job description for the Clinical Operations Director position at Elevancehealth?
Job Overview
">We are seeking a skilled Clinical Operations Director to join our team. As a key member of our medical management staff, you will play a critical role in ensuring timely and consistent medical decisions for our members and providers.
Key Responsibilities
- Support the medical management staff in making timely and consistent medical decisions.
- Makes physician-to-physician calls to gather medical information for determining medical necessity for services requested.
- Makes medical necessity determinations for grievances and appeals.
Requirements
- MD degree and board certification in a medical specialty required.
- 3 years of clinical experience post-residency preferred.
- Board certification in Physical Medicine and Rehab is strongly preferred.
