Elevance Health
Medical Director Associate - Carelon RX
Elevance Health - Mason, Ohio, United States, 45040
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Medical Director Associate - Carelon RX
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Medical Director Associate - Carelon RX
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Elevance Health Medical Director Associate - Carelon RXLocation: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development.The Medical Director Associate is responsible for providing day-to-day guidance, support, and leadership for clinical and/or quality activities under the guidance of a Medical Director. May be responsible for supporting one or more Medical Directors in ensuring clinical integrity of broad and significant clinical programs. May perform clinical review.How you will make an impact: May provide clinical guidance for programs.Supports clinicians to ensure timely and consistent responses to members and providers.Conducts peer-to-peer clinical reviews with attending physicians or other ordering providers to discuss review determinations, and patients’ office visits with providers and external physicians.May conduct peer-to-peer clinical appeal case reviews with attending physicians or other ordering providers to discuss review determinations.May participate in a physician on-call rotation for a 24x7 unit.May assist in the practitioner appeal reviews, appropriateness criteria reviews, medical technology assessments, setting and implementing QI initiatives, and practitioner/provider credentialing.Under direction, may be responsible for the administration of medical services for company health plans including medical policies.Serves as a resource and consultant to other areas of the company.May interpret existing medical policy.May be required to represent the company to external entities and/or serve on internal and/or external committees.Minimum Requirements:Requires MD or DO and Board certification approved by one of the following certifying boards is required, where applicable to duties being performed, American Board of Medical Specialties (ABMS) or American Osteopathic Association (AOA).Must possess an active unrestricted medical license to practice medicine or a health profession.Unless expressly allowed by state or federal law, or regulation, must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US military base, vessel or any embassy located in or outside of the US.Minimum of 5 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.Job Level: Director EquivalentWorkshift: 1st Shift (United States of America)Job Family: MED > Licensed Physician/Doctor/Dentist Seniority level
Seniority level Mid-Senior level Employment type
Employment type Full-time Job function
Job function Health Care Provider Industries Hospitals and Health Care Referrals increase your chances of interviewing at Elevance Health by 2x Get notified about new Medical Director jobs in
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Medical Director Associate - Carelon RX
role at
Elevance Health 2 days ago Be among the first 25 applicants Join to apply for the
Medical Director Associate - Carelon RX
role at
Elevance Health Medical Director Associate - Carelon RXLocation: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development.The Medical Director Associate is responsible for providing day-to-day guidance, support, and leadership for clinical and/or quality activities under the guidance of a Medical Director. May be responsible for supporting one or more Medical Directors in ensuring clinical integrity of broad and significant clinical programs. May perform clinical review.How you will make an impact: May provide clinical guidance for programs.Supports clinicians to ensure timely and consistent responses to members and providers.Conducts peer-to-peer clinical reviews with attending physicians or other ordering providers to discuss review determinations, and patients’ office visits with providers and external physicians.May conduct peer-to-peer clinical appeal case reviews with attending physicians or other ordering providers to discuss review determinations.May participate in a physician on-call rotation for a 24x7 unit.May assist in the practitioner appeal reviews, appropriateness criteria reviews, medical technology assessments, setting and implementing QI initiatives, and practitioner/provider credentialing.Under direction, may be responsible for the administration of medical services for company health plans including medical policies.Serves as a resource and consultant to other areas of the company.May interpret existing medical policy.May be required to represent the company to external entities and/or serve on internal and/or external committees.Minimum Requirements:Requires MD or DO and Board certification approved by one of the following certifying boards is required, where applicable to duties being performed, American Board of Medical Specialties (ABMS) or American Osteopathic Association (AOA).Must possess an active unrestricted medical license to practice medicine or a health profession.Unless expressly allowed by state or federal law, or regulation, must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US military base, vessel or any embassy located in or outside of the US.Minimum of 5 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.Job Level: Director EquivalentWorkshift: 1st Shift (United States of America)Job Family: MED > Licensed Physician/Doctor/Dentist Seniority level
Seniority level Mid-Senior level Employment type
Employment type Full-time Job function
Job function Health Care Provider Industries Hospitals and Health Care Referrals increase your chances of interviewing at Elevance Health by 2x Get notified about new Medical Director jobs in
Mason, OH . Medical Operations Manager/ Practice Manager
Cincinnati, OH $150,160.00-$225,700.00 5 days ago Hamilton County, OH $160,000.00-$180,000.00 1 week ago Permanent - Medical Director | Primary Care | Cincinnati, OH| Making over $300,000
Assistant Director of Clinical Services- Registered Nurse (RN)
Hamilton, OH $90,000.00-$95,000.00 2 weeks ago Hamilton, OH $85,000.00-$90,000.00 1 week ago Blue Ash, OH $50,000.00-$400,000.00 1 week ago Loveland, OH $50,000.00-$400,000.00 1 week ago Fairfield, OH $50,000.00-$400,000.00 2 weeks ago ORTHOPEDICS - MEDICAL PRACTICE MANAGER III
Director, UC Cancer Center, College of Medicine
Mason, OH $50,000.00-$400,000.00 1 week ago Blue Ash, OH $50,000.00-$400,000.00 5 hours ago Cincinnati, OH $50,000.00-$400,000.00 5 hours ago Director of University Health Services, Asst/Assoc/Full Professor, Family & Community Medicine
We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI.
#J-18808-Ljbffr