Medical Director - Medical Oncology at Elevance Health
Base pay range
$94.08/hr - $169.34/hr
Clinical Operations Medical Director in the Medical Oncology practice of Carelon Medical Benefit Management (formerly AIM Specialty Health) is a virtual, full‑time position that supports the medical management staff in making timely and consistent medical decisions for members and providers. The role enables associates to work remotely, with required in‑person training sessions for onboarding and skill development.
Responsibilities
- 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 information for medical necessity determinations.
- Make medical necessity determinations for grievance and appeals appropriate for the specialty.
- Ensure consistent use of company medical policies when making medical necessity decisions.
- Bring case review decisions that require Medical Director review or policy interpretation to the supervisor’s attention.
Minimum Requirements
- MD or DO with board certification from 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. This requirement is waived for Cardiology, Oncology, and Interventional Pain specialties.
- Board certification in the relevant medical specialty.
Preferred Qualifications
- Board certification in Medical Oncology strongly preferred.
- 3–5 years of clinical practice experience past fellowship training desired.
- Demonstrated knowledge of current practice standards in oncology.
Locations
California, Illinois, New Jersey, New York. The salary range for this position is $94.08/hr to $169.34/hr.
Benefits
In addition to the base salary, Elevance Health offers a comprehensive benefits package, incentive and recognition programs, equity stock purchase options, 401(k) contribution, medical, dental, vision coverage, short‑ and long‑term disability benefits, and wellness programs. Eligibility is subject to the standard employment terms and is detailed further by the Company.
Equal Employment Opportunity Statement
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. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
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