Clinical Ops Associate Medical Director - Ortho Location: This is a virtual position. Candidates must reside within 50 miles of an Elevance Health Pulse Point location.
Work schedule: Monday – Friday 8:00am to 5:00pm depending on your zone.
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The Clinical Ops Associate Medical Director - Ortho is responsible for performing pre-authorizations and providing quality improvement solutions for musculoskeletal procedures involving the joints.
How you will make an impact: Determines the medical necessity of requests using clinical criteria.Performs physician-level case review of musculoskeletal utilization requests.Conducts peer-to-peer consultation with ordering physicians, physician assistants and advanced practice nurses regarding established guidelines and accepted standards of care as it relates to treatments, surgical procedures, imaging and appropriate sites of service.Provides education regarding applicable clinical criteria and discusses clinically appropriate alternative surgical and non-surgical treatments.Performs first level provider appeals of coverage decisions.Provides support and education to internal clinical and non-clinical staff regarding the principles associated with appropriate musculoskeletal diagnoses, treatments, and management.Participates in physician team meetings.Participates in groups that develop, revise and enhance clinical appropriateness guidelines.Minimum Requirements: Requires MD or DO and Board certification by the American Board of Orthopedic Surgery or American Osteopathic Board of Orthopedic Surgery.Current unrestricted medical license(s) as a Doctor of Medicine or Doctor of Osteopathic Medicine in appropriate state(s).Experience performing standard orthopedic procedures independently.Preferred Capabilities, Skills and Experiences: Minimum of 3 years of clinical practice experience past fellowship training preferred.Extensive orthopedic surgery experience preferred.Experience with utilization management, especially with CMS guidelines preferred.For candidates working in person or remotely in the below location(s), the hourly* range for this specific position is $114.37 to $204.24.
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).
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.
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.
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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