Elevance Health • Morristown, NJ 07960
Job #2683513582
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.
Senior Medical Director, Clinical UM Operations
Job Family: MED > Licensed Physician/Doctor/Dentist
Type: Full time
Date Posted:Apr 16, 2024
Anticipated End Date:May 24, 2024
Reference: JR112238
Location:
IL, CHICAGO
CA, WOODLAND HILLS
NJ, MORRISTOWN
WI, Waukesha
IN, INDIANAPOLIS
OH, CINCINNATI
CA, WALNUT CREEK
NY, NEW YORK
NH, MANCHESTER
MI, DEARBORN
TN, NASHVILLE
NY, MIDDLETOWN
MN, GILBERT
DC, WASHINGTON
NV, LAS VEGAS
MN, MENDOTA HEIGHTS
VA, NORFOLK
OH, COLUMBUS
CT, WALLINGFORD
MO, ST LOUIS
MD, HANOVER
NJ, ISELIN
DE, WILMINGTON
OH, MASON
OH, SEVEN HILLS
RI, SMITHFIELD
CO, DENVER
FL, MIAMI
TX, FORT WORTH
GA, ATLANTA
NY, LATHAM
VA, RICHMOND
TX, HOUSTON
VA, ROANOKE
MA, WOBURN
FL, TAMPA
Description
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.
Carelon Medical Benefits Management Clinical Operations team is looking to hire a Senior Medical Director to manage a team of physicians performing clinical coverage and determination reviews for our Musculoskeletal (MSK) Solution. (internal title: Manager Clinical Operations Medical Director)
Responsible for providing day-to-day guidance, support, and leadership for the clinical and quality activities and supporting the Medical Directors in ensuring the clinical integrity of broad and significant clinical programs. Position can work 1 day a week from any Elevance Health US corporate location.
Provides support to clinicians in daily tasks and participates in peer-to-peer discussions and office visits with providers and external physicians as necessary.
May participate in a physician on-call rotation for a 24x7 pre-certification unit.
Assists in the practitioner appeal reviews, appropriateness criteria reviews, medical policy and technology assessments, setting and implementing QI initiatives, and practitioner/provider credentialing.
Hires, trains, coaches, counsels, and evaluates performance of direct reports.
Requires MD or DO. Minimum of 5 years clinical experience with expertise in medical management required. Board certification is required where applicable to the duties being performed.
-Leadership experience managing teams of physicians in a utilization management clinical operations business inside a health plan or a UM/benefits management firm.
-Proven experience leading change management initiatives
-Experience with Commercial, Medicaid, and Medicare lines of business
For candidates working in person or remotely in the below locations, the salary* range for this specific position is $211,040 to $379,872
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.
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 Are
Elevance 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 Work
At 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 ~~~ for assistance.
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Elevance Health, Inc. is anE-verify Employer (~~~)
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