Elevance Health • Gilbert, MN 55741
Job #2689517487
Clinical Operations Associate Medical Director
Carelon Medical Benefits Management
Radiology Benefit Management/Utilization Review
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 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:
Preferred Experiences, Capabilities, and Skills:
3 years post residency or fellowship clinical expereince strongly preferred.
Familiar with Outlook, Microsoft Teams and Microsoft Office Suite products strongly preferred.
For candidates working in person or remotely in the below locations, the salary* range for this specific position is $162,801 to $293,055.
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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