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Clinical Operations Associate Medical DirectorCarelon Medical Benefits ManagementVirtual: 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 developmentSchedule: 10:00-7:00 Central TimeA proud member of the Elevance Health family of companies, Carelon Post Acute Solutions, formerly myNEXUS, is the leader in health resource optimization, focused on transforming how healthcare is delivered and promoting the advancement of care for the people we serve.The Clinical Operations Associate Medical Director 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 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 supervisors attention, any case review decisions that require Medical Director review or policy interpretation.Minimum Requirements: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.Preferred Experience, Qualifications, and Capabilities:3 years of clinical experience post residency. Preferably in inpatient post-acute careBoard certified in Physical Medicine and Rehab is strongly preferred.For candidates working in person or virtually in the below location(s), the salary range for this specific position is $179,503 to $307,732.Locations: California, Illinois, New York, Washington StateIn addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Companys sole discretion, consistent with the law.
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