Appeals Medical Director - Medicare

Appeals Medical Director - Medicare

Join to apply for the Appeals Medical Director - Medicare role at Elevance Health
. The position is listed 2 days ago and accepts applications from the first 25 applicants.

$/yr - $/yr

This role enables associates to work virtually full-time, with the exception of required in‑person training sessions, providing maximum flexibility and autonomy. 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. Alternate locations may be considered.

Locations: Illinois;
Maryland, New York.

• Appeal reviews.
• Supports clinicians to ensure timely and consistent responses to members and providers.
• Provides guidance for clinical operational aspects of a program.
• May conduct peer‑to‑peer clinical case reviews with attending physicians or other ordering providers to discuss review determinations.
• Serves as a resource and consultant to other areas of the company.
• May be required to represent the company to external entities and/or serve on internal and/or external committees.
• May chair company committees.
• Interprets medical policies and clinical guidelines.
• May develop and propose new medical policies based on changes in healthcare.
• Leads, develops, directs, and implements clinical and non‑clinical activities that impact health care quality, cost and outcomes.
• Identifies and develops opportunities for innovation to increase effectiveness and quality.

• Requires MD or DO and board certification approved by one of the following certifying boards:
  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.
• Unless expressly allowed by state or federal law, must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a U.S. military base, vessel or any embassy located in or outside of the U.S.
• Minimum of 10 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
• For Health Solutions and Carelon organizations (including behavioral health) only, minimum of 5 years of experience providing health care is required.
• Additional experience may be required by state contracts or regulations if the Medical Director is filling a role required by a state agency.

• Internal Medicine or Family Medicine specialties preferred.
• Utilization Management or Appeals experience preferred.

In addition to your salary, Elevance Health offers a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401(k) contribution (all 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, and local pay equity laws.

We require all new candidates in certain patient/member‑facing roles to become vaccinated against COVID‑19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state, and local laws.

• The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations.
  
  No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the…