Join to apply for the Medical Director – Medical Oncology role at Elevance Health .
Base pay range
$94.08/hr - $169.34/hr
The Clinical Operations Medical Director is responsible for supporting the medical management staff ensuring timely and consistent medical decisions to members and providers, with a focus on medical oncology. This role enables associates to work virtually full‑time, with the exception of required in‑person training sessions, providing maximum flexibility and autonomy.
How you will make an impact
- Perform physician‑level case review, following initial nurse review, of medical‑oncology regimens and supportive care.
- Perform physician‑level case review, following initial nurse review, of chemotherapy regimens.
- Determine medical necessity of requests using guidelines and client‑specific health‑plan medical policy.
- Conduct peer‑to‑peer discussions with ordering physicians, physician assistants, and nurse practitioners to provide education regarding established guidelines and accepted standards of oncology care.
- Document the pre‑certification review in a complete, concise, and accurate manner in the pre‑certification computer application.
- Demonstrate and maintain current knowledge of new cancer treatment regimens.
- Assist pre‑certification nurses and other staff in understanding the principles behind appropriate utilization of covered treatments and genetic testing.
- Participate in periodic physician team meetings.
- Maintain knowledge of relevant policies and regulations pertaining to utilization review of oncology care.
- Participate on committees or in work groups as needed for revision of clinical guidelines and/or serve as a subject matter expert.
- Perform first‑level provider appeals as designated by the client for adverse determinations.
- Obtain additional state licensure based upon business needs.
- Adhere to all company protocols, policies, and procedures.
- Ensure timely completion of clinical case reviews for board‑certified specialty.
- Make physician‑to‑physician calls to gather medical‑appropriate information in order to make medical necessity determinations for services requested.
- Make medical necessity determinations for grievance and appeals appropriate for specialty.
- Ensure consistent use of company medical policies when making medical necessity decisions.
- Bring to supervisors any case review decisions that require Medical Director review or policy interpretation.
Minimum requirements
- MD or DO and Board certification approved by the American Board of Medical Specialties (ABMS) or American Osteopathic Association (AOA).
- Active unrestricted medical license to practice medicine or a health profession.
- Minimum of 1 year of experience with clinical case reviews for medical necessity; waiver for specific specialties (cardiology, oncology, interventional pain).
- Board certification in a medical specialty.
Preferred qualifications
- Board Certification in Medical Oncology strongly preferred.
- 3‑5 years of clinical practice experience past fellowship training.
- Demonstrated knowledge of current practice standards in oncology.
The salary range for this position is $94.08/hr to $169.34/hr.
Locations: California, Illinois, New Jersey, New York.
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 (subject to eligibility requirements).
Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender, marital status, national origin, race, religion, sex, sexual orientation, veteran status, or any other protected characteristic. Applicants who require accommodation to participate in the job application process may contact for assistance.
Seniority level
Mid‑Senior level
Employment type
Full‑time
Job function
Management
Business Consulting and Services