Medical Director – Post Acute Care

Clinical Operations Medical Director

Carelon Medical Benefits Management

Post Acute Care Benefit Utilization Management

Schedule: 10:00AM-7:00PM CT on Weekdays; 7:00AM-4:00PM CT on weekend coverage day. One weekend day coverage required.

Part Time and Full Time options available to include a weekend day.

Virtual: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development.

Note:

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.

• Ensures timely completion of clinical case reviews for their board certified specialty.
• Makes physician-to-physician calls to gather medical appropriate information in order to make medical necessity determinations for services requested.
• Makes medical necessity determinations for grievance and appeals appropriate for their specialty.
• Ensures consistent use of company medical policies when making medical necessity decisions.
• Brings to their supervisors attention any case review decisions that require Medical Director review or policy interpretation.

• MD/DO and Board certification approved by one of the following certifying boards: ABMS or 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. The minimum 1 year of experience would be waived for the following specific specialties only:
  Cardiology, Oncology, and Interventional Pain specialties.
• Board certification in a medical specialty required.

• 3 years of clinical experience post residency. Preferably in inpatient post-acute care.
• Board certified in Physical Medicine and Rehab is preferred.

Salary Range
: $179,503 to $307,732 for candidates working in person or virtually at the following locations.

Locations: California, Illinois, Nevada, Washington State.

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, and local pay equity laws.

Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

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, and local laws.

Applicants who require accommodation to participate in the job application process may contact elevancehealthj 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.