Medical Director

Medical Director – Medical Oncology Company: Elevance Health (Carelon Medical Benefit Management) We are looking for an experienced Medical Director with a specialty in Medical Oncology to lead our Clinical Operations. The role is fully virtual full‑time, with required in‑person training sessions for onboarding and skill development. Responsibilities Perform physician‑level case review of Medical Oncology regimens and supportive care. Perform physician‑level case 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 in work groups 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 upon business needs. Adhere to all company 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 for medical necessity determinations. 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 any case review decisions that require Medical Director review or policy interpretation. Minimum Requirements MD or DO with board certification in a relevant specialty (American Board of Medical Specialties or American Osteopathic Association). 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, and 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 after fellowship training desirable. Demonstrated knowledge of current practice standards in oncology. Compensation and Benefits Hourly rate: $94.08 to $169.34, based on geographic location, experience, and education. Comprehensive benefits package, incentive and recognition programs, equity stock purchase plan, and 401(k) contribution. Benefits subject to eligibility requirements. Salary range represents a realistic estimate and may be modified in the future; actual compensation is determined by various factors. Locations California Illinois New Jersey New York Equal Employment Opportunity Statement Elevance Health is an Equal Employment Opportunity employer. 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 protected by applicable federal, state, or local laws. Accommodation requests for the job application process may be made to elevancehealthjobssupport@elevancehealth.com. #J-18808-Ljbffr