Associate Medical Director - Outpatient Rehab

About the role

The Clinical Operations Associate Medical Director is responsible for supporting the medical management staff ensuring timely and consistent medical decisions to members and providers. They ensure timely completion of clinical case reviews for their board-certified specialty, make physician to physician calls to gather medical appropriate information, make medical necessity determinations for services requested, ensure consistent use of medical policies when making medical necessity decisions, and bring to their supervisors attention any case review decisions that require Medical Director review or policy interpretation.

Responsibilities

• 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.
• Safeguards consistent use of medical policies when making medical necessity decisions.
• Briefs supervisors on any case review decisions requiring 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 Skills, Capabilities, and Experiences

• PMR Board Certification preferred.
• Experience in Inpatient or outpatient rehab.
• Experience with Microsoft Office Suite.

Benefits

For candidates working in person or virtually in the below location(s), the salary range for this specific position is $188,051 to $294,910. Locations: California, Illinois. In 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).

Pay

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.

Schedule

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.