Medical Director - Medical Oncology

Anticipated End Date:

Position Title: Medical Director - Medical Oncology

Job Description:

Virtual:
This role enables associates to work virtually full-time, with the exception of required in‑person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work‑life integration, and ensures essential face‑to‑face onboarding and skill development.

Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.

A proud member of the Elevance Health family of companies, Carelon Medical Benefits Management, formerly AIM Specialty Health, is a benefit‑management leader in Illinois. Our platform delivers significant cost‑of‑care savings across an expanding set of clinical domains, including radiology, cardiology and oncology.

The Clinical Operations Medical Director is responsible for supporting the medical management staff in ensuring timely and consistent medical decisions for members and providers.

• Perform physician‑level case review, following initial nurse review, of Medical Oncology regimens and supportive care.
• Perform physician‑level case review, following initial nurse review, of chemotherapy regimens.
• Determine medical necessity of requests using guidelines and client‑specific health plan medical policy.
• Conduct peer‑to‑peer discussions with ordering physicians, physician assistants, and nurse practitioners to provide education regarding established guidelines and accepted standards of oncology care.
• Document the pre‑certification review in a complete, concise, and accurate manner in the pre‑certification computer application.
• Demonstrate and maintain current knowledge of new cancer treatment regimens.
• Assist pre‑certification nurses and other staff in understanding the principles behind appropriate utilization of covered treatments and genetic testing.
• Participate in periodic physician team meetings.
• Maintain knowledge of relevant policies and regulations pertaining to utilization review of oncology care.
• Participate on committees or in work groups as needed for revision of clinical guidelines and/or serve as a subject‑matter expert.
• Perform first‑level provider appeals as designated by the client for adverse determinations.
• Obtain additional state licensure based upon business needs.
• Adhere to all company protocols, policies, and procedures.
• Ensure timely completion of clinical case reviews for the board‑certified specialty.
• Make physician‑to‑physician calls to gather medical‑appropriate information in order to make medical necessity determinations for services requested.
• Make medical necessity determinations for grievance and appeals appropriate for the specialty.
• Ensure consistent use of company medical policies when making medical necessity decisions.
• Bring to supervisors attention any case review decisions that require Medical Director review or policy interpretation.

• MD or DO with board certification approved by the American Board of Medical Specialties (ABMS) or American Osteopathic Association (AOA).
• Active unrestricted medical license to practice medicine or a health profession.
• Minimum of 1 year of experience with clinical case reviews for medical necessity (waived for Cardiology, Oncology, and Interventional Pain specialties).
• Board certification in a medical specialty required.

• Board Certification in Medical Oncology (strongly preferred).
• 3–5 years of clinical practice experience post‑fellowship training desired.
• Demonstrated knowledge of current practice standards in oncology.

For candidates working in person or virtually in the below location(s), the salary
* range for this specific position is $94.08 /hr to $169.34 /hr.

Locations:
California, Illinois, New Jersey, New York

In addition to your salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock…