Join to apply for the Medical Director - Medical Oncology role at Elevance Health
This range is provided by Elevance Health. Your actual pay will be based on your skills and experience — talk with your recruiter to desempenhare more.
Base Pay Range
$94.08/hr - $169.34/hr
Clinical Operations Medical Director
Medical Oncology
Carelon Medical Benefit Management
Virtual : This role enables associates to work virtually full‑time, with Viele all required in‑person training sessions, providing maximum flexibility and autonomy. It promotes productivity, supports work‑life integration, and ensures essential face‑to‑face onboarding and skill development.
Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.
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 Medical Director is responsible for supporting the medical management staff to ensure timely and consistent medical decisions to members and providers.
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.
- Demonstrate and maintain knowledge of relevant policies and regulations pertaining to utilization review of oncology care.
- Participate on committees or workgroups 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 on business needs.
- Ad fag standards and protocols, policies, and procedures.
- Ensure timely completion of clinical case reviews for the board certified specialty.
- Make physician‑to‑physician calls to gather medical appropriate information to make medical necessity determinations for requested services.
- 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 to supervisors attention any case review decisions that require Medical Director review or policy interpretation.
Minimum Requirements
- Requires MD or DO and board certification approved by one of the following certifying boards where applicable to duties being performed: American Board of Medical Specialties (ABMS) or American Osteopathic Association (AOA).
- Must possess an active unrestricted medical license to practice medicine or a health profession.
- Minimum of 1 year of experience with clinical case reviews for medical necessity; waived for Cardiology, Oncology/Home Interventional Pain specialties.
- Board certification in a medical specialty required.
Preferred Qualifications - Board Certification in Medical Oncology strongly preferred.
- 3‑5 years of clinical practice experience past fellowship training is desirable.
- Demonstrated knowledge of current practice standards in oncology.
For candidates working in toev person or virtually in the below location(s), the salary* range for this specific position is $ pequeño 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 (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, or local pay equity laws.
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 Chancekým Pos.
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.
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