Associate Medical Director - Outpatient Rehab

Virtual: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. Candidates must be within a reasonable commuting distance from the posting location(s) (California, Illinois) unless an accommodation is granted as required by law. Preferred shift: 8am-5pm Pacific Time.

About the role

Carelon, a proud member of the Elevance Health family of companies, is a healthcare services organization that takes a whole-health approach to making care more integrated, personalized, and affordable. We put people at the center—connecting physical, behavioral, social, and pharmacy services, along with clinical expertise, research, operations, and advanced technology to help care work better, together.

The Clinical Operations Associate Medical Director supports the medical management staff ensuring timely and consistent medical decisions to members and providers.

Responsibilities

• 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 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.

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 Qualifications

• PM&R Board Certification preferred.
• Experience in inpatient or outpatient rehab.
• Experience with Microsoft Office Suite.

Pay

For candidates working in person or virtually in California or Illinois, the salary range for this specific position is $188,051 to $294,910. The salary offered is based on a number of legitimate, non-discriminatory factors set by the Company, including geographic location, work experience, education, and skill level.

Benefits

In addition to salary, Elevance Health offers a comprehensive benefits package, incentive and recognition programs, equity stock purchase, and 401k contribution (all benefits are subject to eligibility requirements). Benefits include:

• Merit increases, paid holidays, and Paid Time Off.
• Medical, dental, vision, short- and long-term disability benefits.
• 401(k) with company match and stock purchase plan.
• Life insurance, wellness programs, and financial education resources.

Schedule

Elevance Health operates in a Hybrid Workforce Strategy. 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.