- Perform physician-level case review, following initial nurse review, of Medical Oncology regimens and supportive care.
- Perform physician-level case review, following initial nurse review, of chemotherapy regimens.
- Determine medical necessity of requests using guidelines and client-specific health plan medical policy.
- Conduct peer-to-peer discussions with ordering physicians, physician assistants, and nurse practitioners to provide education regarding established guidelines and accepted standards of oncology care.
- Document the pre-certification review in a complete, concise, and accurate manner in the pre-certification computer application.
- Demonstrate and maintain current knowledge of new cancer treatment regimens.
- As necessary, assist pre-certification nurses and other staff in understanding the principles behind appropriate utilization of covered treatments and genetic testing.
- Participate in periodic physician team meetings.
- Demonstrate and maintain knowledge of relevant policies and regulations pertaining to utilization review of oncology care.
- Participate on committees or in work groups as needed for revision of clinical guidelines and/or serve as a subject matter expert.
- Perform first level provider appeals as designated by the client for adverse determinations.
- Obtain additional state licensure based upon business needs.
- Adhere to all company protocols, policies, and procedures.
- Requires an MD and minimum of 1 year of experience with clinical case reviews for medical necessity. The minimum of 1 year of experience with clinical case reviews would be waived for the following specific specialties only; Cardiology, Oncology, and Interventional Pain specialties.
- Board certification in a medical specialty required.
- Board Certification in Medical Oncology strongly preferred.
- 3-5 years of clinical practice experience past fellowship training is desirable.
- Demonstrated knowledge of current practice standards in oncology.
- Strong oral communication and interpersonal skills.
- Intermediate computer skills (including MS Office and Outlook), ability to learn new applications.
- Strong analytical skills.
- Ability to multi-task.
- Ability to work both independently and in a team environment.
- Ability to work in a dynamic, fast-paced environment.
- 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.
-
Medical Director
1 week ago
Peoplepack LLC Los Angeles, United StatesWe are recruiting for a Medical Director to join a small animal GP hospital located on the upscale West Side of Los Angeles, with close access to beach, mountains, Hollywood and DTLA. · This is a privately owned veterinary practice that offers state of the art equipment, collabor ...
-
physician medical director remote- hospice
4 days ago
Medical Clinic San Gabriel, United StatesJob Description · Job DescriptionMEDICAL DIRECTOR-PHYSICIAN · FOR HOSPICE ONLY 15 PATIENTS · REMOTE ONLY $1,000 MONTHLY · Company DescriptionMEDICAL PRACTICE · MEDICAL CARECompany Description · MEDICAL PRACTICE\r · \r · \r · \r · \r · \r · \r · \r · \r · \r · \r · \r · \r · \r · ...
-
Medical Director, Medical Management
1 week ago
L.A. Care Health Plan Los Angeles, United StatesMedical Director, Medical Management · **Job Category**:Clinical**Department**:Utilization Management**Location**:Los Angeles, CA, US, 90017**Position Type**:Full Time**Requisition ID**:11134**Salary Range**: $206, Min.) - $278, Mid.) - $350, Max.)- Established in 1997, L.A. Care ...
-
Medical Director
1 week ago
Quantum Ventures Redondo Beach, United StatesThere are many reasons to collaborate with European Medical Consulting Adam in Redondo Beach. In the following section, you will see how you can benefit from our free services and save valuable time: · Exclusive access to unpublished job opportunities · Relocation assistance prov ...
-
Medical Director Veterinarian
1 week ago
Peoplepack Santa Monica, United StatesWe are recruiting for a financially driven Veterinarian leader who is interested in managing a brand-NEW GP hospital, growing a veterinary team, and reaping the financial benefits of being a practice owner, all while enjoying the beautiful beaches, weather and energetic lifestyle ...
-
Specialty Medical Director
1 day ago
Thrive Pet Healthcare Torrance, United StatesThrive Pet Healthcare is seeking to add a Specialty Medical Director to these several locations across the country · - ACCESS San Fernando Valley, CA · - ACCESS South Bay, Torrance, CA · - CARE Veterinary Center, Frederick, MD · - Thrive Pet Healthcare Specialists of Mansfield, S ...
-
Veterinary Medical Director
1 day ago
ACCESS South Bay Torrance, United States**Thrive Pet Healthcare is looking to hire a Medical Director for ACCESS South Bay in Torrance, CA.** · Join our community of veterinary care providers for the support, tools, and resources to elevate your practice and provide top-notch patient care. We believe in your abilities ...
-
Director of Medical Mgmt
1 week ago
Elevance Health Woodland Hills, United States· A proud member of the Elevance Health family of companies, Carelon Medical Benefits Management is a benefit-management leader in Illinois. Our platform delivers significant cost-of-care savings across an expanding set of clinical domains, including radiology, cardiology, oncol ...
-
Medical Director of Population Health
2 days ago
UCLA Health Los Angeles, United States**Description** · The Medical Director of Population Health is a member of the senior leadership team of the UCLA Health Faculty Practice Group (FPG). · Under the direction of the FPG CMO, the Medical Director of Population Health works in a dyad relationship with the Director of ...
-
Director Nursing Medical Surgical
6 days ago
California Hospital Medical Center Los Angeles, United States**Overview** · If you are committed to social justice, health equity, and prepared to deliver care in new, innovative ways, you belong with us. · We offer the following benefits to support you and your family: · - Relocation Assistance. · - Annual Incentive (Bonus) Program. · - M ...
-
Medical Director, Veterinarian Los Angeles
2 days ago
Carlsen Animal Hospital Los Angeles, United States**Medical Director, **Veterinarian** · **Carlsen Animal Hospital**, a Thrive Pet Healthcare partner, we recognize what you and your team face each day. Through our collaborative community of veterinary care providers, you'll have the support, tools, and resources you need to take ...
-
Hollywood Presbyterian Los Angeles, United StatesCHA Hollywood Presbyterian (CHA HPMC) is a nationally recognized acute care facility that has been caring for the Hollywood community and Los Angeles Areas since 1924. · **Join our Global Network and be a CHA Global Ambassador** · CHA HPMC is also a part of the world-renown CHA H ...
-
Hospitalist Medical Director
1 week ago
Dignity Health Northridge, United States**Overview** · Established in 1976, Dignity Health Medical Group - Northridge is a service of Dignity Health Medical Foundation. We are aligned with Dignity Health, one of the largest health systems in California. We are recruiting an experienced Hospitalist Director (adult medic ...
-
Amgen Thousand Oaks, United States**HOW MIGHT YOU DEFY IMAGINATION?** · If you feel like you're part of something bigger, it's because you are. At Amgen, our shared mission—to serve patients—drives all that we do. It is key to our becoming one of the world's leading biotechnology companies. We are global collabor ...
-
Medical Director, Risk Adjustment
1 week ago
Regal Medical Group, Inc. Northridge, United StatesJob Description · The Medical Director of Risk Adjustment is responsible and accountable for the performance of a specific region in terms of RAF score for all product lines that risk adjust and quality scores for all product lines. The Medical Director will be working with inter ...
-
Medical Director Risk Adjustment
4 days ago
AMI Network Los Angeles, United StatesJob Description · Job DescriptionWe're partnered with a large HMO headquartered in Los Angeles to find a Full-Time Medical Director to lead a team of 10 · As the leader of the Risk Department, you'll oversee a mixture of project managers and physician trainers, provide documenta ...
-
La Hyperbaric Oxygen Center LLC Calabasas, United StatesJob Description · Job DescriptionWe are OxygenWell Hyperbaric Oxygen Center. We are expanding to a beautiful medical spa in Calabasas next month and looking for a part-time MD or DO to be our medical director. · Ideal candidate has interest in anti-aging medicine or regenerative ...
-
La Hyperbaric Oxygen Center LLC Calabasas, United StatesJob Description · Job DescriptionWe are OxygenWell Hyperbaric Oxygen Center. We are expanding to a beautiful medical spa in Calabasas next month and looking for a part-time MD or DO to be our medical director. · Ideal candidate has interest in anti-aging medicine or regenerative ...
-
Bht Swing Tech Residential Detox
2 days ago
Profound Treatment Woodland Hills, United StatesProfound Treatment is seeking a full time Behavioral Health Technician/Driver for its residential detox program. The Behavioral Health Technician will help facilitate clients through their day and evening programming schedules in a detox/residential substance abuse treatment sett ...
-
Health Info Mgmt Clerk Ii
1 week ago
Tarzana Treatment Center Woodland Hills, United States**Position Title**:HIM Clerk II · **Department**:HIM/or assigned department · **Reports To**:HIM Supervisor or appropriate site supervisor · ***: · The HIM Clerk II is responsible for the accurate processing of discharge medical records to assure they are complete, retrievable, p ...
Medical Oncology Medical Director - Woodland Hills, United States - Elevance Health
Description
Clinical Operations Medical Director
Utilization Management of Medical Oncology Benefits
Carelon Benefits Management
$20,000 Sign On Bonus
Location : The ideal candidate will live within 50 miles of one of our Elevance Health PulsePoint locations with the opportunity to work remotely from home.
A proud member of the Elevance Health family of companies, Carelon Medical Benefits Management, formerly AIM Specialty Health, is a benefit-management leader in Illinois. Our platform delivers significant cost-of-care savings across an expanding set of clinical domains, including radiology, cardiology and oncology.
The Clinical Operations Medical Director supporting our Medical Oncology team is responsible for supporting the medical management staff ensuring timely and consistent medical decisions to members and providers.
Job Summary:
Minimum Requirements:
Preferred Qualifications:
For candidates working in person or remotely in the below locations, the salary* range for this specific position is $188,177 to $338,707.
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 .
