Behavioral Health Medical Director - Psychiatrist Appeals

Behavioral Health Medical Director - Psychiatrist Appeals

Location: This role enables associates to work virtually full‑time, with the exception of required in‑person training sessions, providing maximum flexibility and autonomy. Alternate locations can be considered. Please note that 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.

Work schedule: Monday – Friday. Half‑day Saturday rotation, once a month.

• Supports clinicians to ensure timely and consistent responses to members and providers.
• Provides guidance for clinical operational aspects of a program.
• Conducts peer‑to‑peer clinical appeal 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.
• Might 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.
• Provides oversight, direction, and guidance to Medical Director Associates.
• Works independently with oversight from immediate manager.
• Might be responsible for an entire clinical program and/or independently performs clinical reviews.
• Typically has program‑management responsibilities including clinical policy development, improvement of quality, cost and outcomes, program development/implementation, and overseeing clinical/non‑clinical activities.

• MD or DO with board certification from one of the following certifying boards:
  American Board of Medical Specialties (ABMS) or American Osteopathic Association (AOA).
• Active, unrestricted medical license to practice medicine or health profession.
• Must be located in a U.S. state or territory 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 an equivalent combination of education and experience.
• 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 filing a role required by a state agency.

• Child and Adolescent experience preferred.
• Utilization Management experience.
• Applied Behavior Analysis (ABA) experience.
• Active, unrestricted medical license to practice medicine or health profession in California, or ability to obtain upon hire.

Compensation & Benefits

For candidates working in person or virtually in the locations below, the salary range for this position is $274,068 to $428,976. Locations:
Costa Mesa, CA;
Walnut Creek, CA;
Woodland Hills, CA.

In addition to salary, Elevance Health offers a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401(k) contribution. Salary is based on legitimate, non‑discriminatory factors set by the company. Equal pay opportunities for equal work are ensured pursuant to federal, state, and local pay equity laws.

The salary range is the range Elevance Health 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. No amount is considered wages until earned, vested, and determinate under policies and plans. Bonus, commission, benefits or other compensation are at the company’s discretion.

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Unsolicited resumes are deemed the property of Elevance Health.