Medical Director Associate

Please note this is the target date and is subject to change. BCForward will send official notice ahead of a confirmed start date.

Elevance 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.

• May provide clinical guidance for programs. Supports clinicians to ensure timely and consistent responses to members and providers.
• Conducts peer-to-peer clinical reviews with attending physicians or other ordering providers to discuss review determinations, and patients' office visits with providers and external physicians.
• May conduct peer-to-peer clinical appeal case reviews with attending physicians or other ordering providers to discuss review determinations.
• May participate in a physician on-call rotation for a 24x7 unit.
• May assist in the practitioner appeal reviews, appropriateness criteria reviews, medical technology assessments, setting and implementing QI initiatives, and practitioner/provider credentialing.
• Under direction, may be responsible for the administration of medical services for company health plans including medical policies.
• Serves as a resource and consultant to other areas of the company.
• May interpret existing medical policy.
• May be required to represent the company to external entities and/or serve on internal and/or external committees.
• This level typically is more of a supportive position with oversight from a Medical Director.
• May be responsible for a portion of a clinical program and/or performing clinical reviews. Is more involved in supporting one or more Medical Directors, as well as the programs to which the Medical Director is assigned.
• May manage pieces of programs but would not have the full scope of program management expected of the Medical Director.
• Receives guidance and oversight from a Medical Director who is an individual contributor in addition to direction received from immediate manager.
• Ensures timely completion of clinical case reviews for post-acute care.
• 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 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.

Requires MD or 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. Unless expressly allowed by state or federal law, or regulation, must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US military base, vessel or any embassy located in or outside of the US.

Minimum of 5 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.

Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

Possible Contract to hire

Monday–Friday between the hours of 7AM
-7PM CST.
Full-time…