Medical Director
1 day ago
Elevance Health is seeking a highly skilled Medical Director - Appeals Specialist to join our team. As a Medical Director - Appeals Specialist, you will be responsible for leading the appeals process for physical health medical services, ensuring that members receive the most cost-effective and appropriate medical care.
Key Responsibilities:- Lead the appeals process for physical health medical services
- Ensure that members receive the most cost-effective and appropriate medical care
- Develop and implement programs to improve quality, cost, and outcomes
- Provide clinical consultation and serve as a clinical/strategic advisor to enhance clinical operations
- Identify cost of care opportunities
- Serve as a resource to staff, including Medical Director Associates
- May be responsible for an entire clinical program
- 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)
- Active unrestricted medical license to practice medicine or a health profession
- 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
- Board certification in Internal or Family medicine
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, or local laws.
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