Medical Director - Post Acute Care

About the role

The Clinical Operations Medical Director will support the medical management staff in ensuring timely and consistent medical decisions for members and providers. Key responsibilities include completing clinical case reviews, making medical necessity determinations, and bringing cases requiring Medical Director review to supervisors' attention.

Responsibilities

• Completes clinical case reviews for medical necessity
• Makes physician to physician calls to gather necessary medical information
• Makes medical necessity determinations for grievances and appeals
• Safeguards consistent use of company medical policies
• Briefs supervisors on cases requiring Medical Director review or policy interpretation

Requirements

• MD/DO with board certification from ABMS or AOA
• Minimum 1 year of experience with clinical case reviews (waived for Cardiology, Oncology, and Interventional Pain specialties)
• Board certification in a medical specialty required

Qualifications

• Active unrestricted medical license to practice medicine or a health profession
• Preferred: Board certified in Physical Medicine and Rehabilitation

Skills

• Strong clinical judgment and decision-making skills
• Excellent communication and interpersonal skills
• Ability to manage multiple tasks and prioritize effectively

Benefits

• Virtual work option with occasional in-person training sessions
• Part-time options with at least one weekend day per week
• Flexible schedule: 11:00AM-8:00PM CT, with one weekend shift per month
• Comprehensive benefits package including medical, dental, vision, disability, retirement plans, and wellness programs

Pay

$10, 000 sign-on bonus

Schedule

Full-time position with a flexible schedule: 11:00AM-8:00PM CT, with one weekend shift per month. Part-time options available with at least one weekend day per week. Virtual work option with occasional in-person training sessions.

Alternate Locations

Candidates residing within a reasonable commuting distance from an office may be considered for alternate locations. Please note that 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.

Elevance Health

Elevance Health is a health company dedicated to improving lives and communities. 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. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs, medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. 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. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.