Clinical Operations Associate Medical DirectorCarelon Medical Benefits Management Radiology Benefit Management/Utilization Review Schedule: Monday-Friday 9AM-5PM Central Time
Location: Alternate locations may be considered. The ideal candidate will live within 50 miles of one of our Elevance Health PulsePoint locations.
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 medically 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 supervisor's 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 Experiences, Capabilities, and Skills:3 years post residency or fellowship clinical experience strongly preferred.Familiar with Outlook, Microsoft Teams and Microsoft Office Suite products strongly preferred.Advanced level computer skills preferred.
#J-18808-Ljbffr