Orthopedic Surgery Associate Medical Director

About the role

The Clinical Operations Associate Medical Director - Orthopedic Surgery role enables associates to work virtually full-time, with the exception of required in-person training sessions, promoting productivity, work-life integration, and essential face-to-face onboarding and skill development. Alternate locations may be considered if candidates reside within a commuting distance from an office.

Responsibilities

• Determines the medical necessity of requests using clinical criteria.
• Performs physician-level case review of musculoskeletal utilization requests.
• Conducts peer-to-peer consultation with ordering physicians, physician assistants, and advanced practice nurses regarding established guidelines and accepted standards of care.
• Provides education regarding applicable clinical criteria and discusses clinically appropriate alternative surgical and non-surgical treatments.
• Performs first level provider appeals of coverage decisions.
• Supports and educates internal clinical and non-clinical staff regarding the principles associated with appropriate musculoskeletal diagnoses, treatments, and management.
• Participates in physician team meetings.
• Participates in groups that develop, revise, and enhance clinical appropriateness guidelines.

Requirements

• MD or DO and Board certification by the American Board of Orthopedic Surgery or American Osteopathic Board of Orthopedic Surgery.
• Current unrestricted medical license(s) as a Doctor of Medicine or Doctor of Osteopathic Medicine in appropriate state(s).
• Minimum of 5 years of clinical practice experience past fellowship training preferred.
• Extensive orthopedic surgery experience preferred.
• Experience with utilization management, especially with CMS guidelines preferred.

Preferred Capabilities, Skills And Experiences

• Minimum of 5 years of clinical practice experience past fellowship training preferred.
• Extensive orthopedic surgery experience preferred.
• Experience with utilization management, especially with CMS guidelines preferred.

Benefits

Carelon, a proud member of the Elevance Health family of companies, offers a comprehensive benefits package, incentive and recognition programs, equity stock purchase, and a 401(k) contribution. Additional benefits include a comprehensive benefits package, incentive and recognition programs, equity stock purchase, and a 401(k) contribution (all benefits are subject to eligibility requirements).

Pay

For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $128.28/hr to $192.42/hr.

Schedule

Associates are required to work at an Elevance Health location at least once per week, and potentially several times per week.

Who We Are

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.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

Elevance Health

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 elevancehealthjobssupport@elevancehealth.com 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. Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration.