WARNING: Please beware of phishing scams that solicit interviews or promote work-at-home opportunities, some of which may pose as legitimate companies. Elevance Health requires a completed online application for consideration of employment for any position. We will never ask you for a credit card, send you a check, or ask you for payment as part of consideration for employment.Clinical Operations Medical Director Lead - Post Acute Care
Job Family: Medical and Clinical
Type: Full time
Date Posted:Feb 29, 2024
Anticipated End Date:Mar 07, 2024
Reference: JR107037
Location:
TN, BRENTWOOD
DescriptionClinical Operations Medical Director LeadCarelon Insights/ Medical Benefits ManagementPost Acute SolutionsThe Clinical Operations Medical Director Lead is responsible for leading physician efforts in supporting the medical management staff ensuring timely and consistent medical decisions to members and providers.How you will make an impact:
Provides oversight to physicians and 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.
Educates and provides direct medical coverage decision support as needed for team of physician advisors.
Serves as a mentor and subject matter expert to the physician team.
Assists manager with goal setting for the physician team. Supports physician manager in quarterly and annual physician performance reviews.
Minimum Requirements:
Requires an MD.
Minimum of 2 years experience with clinical case reviews for medical necessity required.
Board certification in a medical specialty required.
Preferred Skills, Experiences, and Qualifications:
2 years’ experience with clinical case reviews and 1 year of experience with post-acute clinical case reviews for medical necessity strongly preferred.
Leadership experience preferred.
Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.Who We AreElevance 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 WorkAt 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.We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), 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. Unless specified as primarily virtual by the hiring manager, 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. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.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. 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 [email protected] for assistance.EEO is the LawEqual Opportunity Employer / Disability / VeteranPlease use the links below to review statements of protection from discrimination under Federal law for job applicants and employees.
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