at Elevance Health in CHICAGO, Illinois, United States
Job Description
Clinical Operations Associate Medical Director
Carelon Health
Genetics Testing Utilization Review
Location : The ideal candidate will live within 50 miles of one of our Elevance Health PulsePoint locations but will have options for work from home.
Schedule: Monday – Friday, 9 AM-5:30 PM in time zone candidate resides.
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 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:
+ Ensures timely completion of clinical case reviews for their board certified specialty.
+ Makes physician to physician calls to gather medical appropriate information in order to make medical necessity determinations for services requested.
+ Makes medical necessity determinations for grievance and appeals appropriate for their specialty.
+ Ensures consistent use of medical policies when making medical necessity decisions.
+ Brings to their supervisors attention, any case review decisions that require Medical Director review or policy interpretation.
Minimum Requirements:
+ Requires an MD and Board certification in a medical specialty required
Preferred Skills, Capabilities, and Experiences:
+ Primary Care/Internal Medicine Board Certification preferred.
+ Knowledge/Experience in Genetic Testing preferred but not required.
+ Compact License or residing in a Compact State strongly preferred.
For candidates working in person or remotely in the below location(s), the salary* range for this specific position is $162,801 to $293,055.
Locations:
California; Colorado; Nevada; New York; Washington State
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 .
- 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.