Medical Oncology Medical Director
1 week ago
Job Title: Clinical Operations Medical Director
Company: Carelon Benefits Management
The job is for a Clinical Operations Medical Director to support the Medical Oncology team at Carelon Benefits Management, a leader in benefit-management in Illinois part of the Elevance Health family of companies.
Job Summary:
- Perform physician-level case review, following initial nurse review, of Medical Oncology regimens and supportive care.
- 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 in committees or work groups for revision of clinical guidelines and serve as a subject matter expert.
- Perform first level provider appeals for adverse determinations.
- Adhere to all company protocols, policies, and procedures.
Minimum Requirements:
- Requires an MD and minimum of 1 year of experience with clinical case reviews for medical necessity. Waived for specific specialties only.
- 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 desirable.
- Demonstrated knowledge of current practice standards in oncology.
- Strong oral communication and interpersonal skills.
- Intermediate computer skills, ability to learn new applications.
- Strong analytical skills.
- Ability to multi-task.
- Ability to work both independently and in a team environment.
- Ability to work in a dynamic, fast-paced environment.
The salary range for this position is $188,177 to $338,707 depending on location and experience.
Job Level: Non-Management Non-Exempt
Workshift: 1st Shift (United States of America)
Job Family: MED > Licensed Physician/Doctor/Dentist
Who We Are
Elevance Health is a Fortune 25 company in the healthcare industry, dedicated to improving lives and communities.
How We Work
Elevance Health offers a range of total rewards including merit increases, paid holidays, Paid Time Off, and incentive bonus programs, medical, dental, vision, short and long term disability benefits, and more.
Elevance Health operates in a Hybrid Workforce Strategy requiring associates to work at least once per week at an Elevance Health location.
Elevance Health is an Equal Employment Opportunity employer with a commitment to ensuring equal pay opportunities.
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