- Ensures timely completion of clinical case reviews for post-acute care.
- Makes physician to physician calls to gather medical appropriate information in order to make medical necessity determinations for services requested.
- Ensures consistent use of company medical policies when making medical necessity decisions.
- Brings to their supervisors attention, any case review decisions that require Medical Director review or policy interpretation.
- Requires an MD or DO Degree.
- Board Certification in medical specialty. Physical Medicine and Rehabilitation, Internal Medicine, Family Medicine, or a closely related adult medical field preferred.
- 3 years of clinical experience post residency. Preferably in inpatient post-acute care.
- 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 Company's sole discretion, consistent with the law.
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Associate Medical Director - California, United States - Elevance Health
Description
Clinical Operations Associate Medical Director
Carelon Insights
Post Acute Care Utilization Review
Schedule: 11-8 Central Time
A 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:
Minimum Requirements:
Preferred Experience, Qualifications, and Capabilities:
For candidates working in person or remotely in the below locations, the salary* range for this specific position is $158,724 to $285,688.
Locations: California; Colorado; Hawaii; Nevada; New York; Washington State; Jersey City, NJ
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). 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 .
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