Associate Medical Director, Clinical Operations (Surgery)

$203,507 - $203,507/Yr

Elevance Health - Chicago, IL

Full-time - Senior

Remote - Chicago, IL

11-50 employees

Insurance Carriers and Related Activities

About the position

The Associate Medical Director, Clinical Operations (Surgery) at Elevance Health is responsible for overseeing medical management staff to ensure timely and consistent medical decisions regarding surgical procedures. This role involves determining the medical necessity of requests, conducting peer consultations, and providing education on clinical criteria. The position is remote but requires the candidate to live within 50 miles of an Elevance Health PulsePoint location.

Responsibilities

• Determine medical necessity of requests using applicable clinical criteria.
• Perform physician-level case review of utilization requests involving surgical procedures.
• Conduct peer-to-peer consultations with ordering physicians regarding established guidelines.
• Discuss clinically appropriate alternative treatments with ordering providers.
• Provide education regarding applicable clinical criteria.
• Perform first level provider appeals of coverage decisions.
• Maintain knowledge of clinical criteria and relevant policies for utilization review.
• Support and educate internal staff on surgical diagnoses and management.
• Participate in physician team meetings and groups developing clinical guidelines.
• Obtain additional state licensure as needed.
• Adhere to Carelon Medical Benefits Management protocols.

Requirements

• MD and Board certification in a medical specialty required.
• Current unrestricted medical license(s) in an appropriate state.
• American Board of Medical Specialties board certification in General Surgery or other surgical specialties.
• 3-5 years of clinical practice experience past fellowship training is desirable.
• Demonstrated knowledge of current practice standards in surgical care.
• Strong oral communication and interpersonal skills.
• Computer literacy with the ability to learn new applications.
• Strong analytical skills.
• Ability to multi-task and work independently or in a team.

Nice-to-haves

• Preferred interest in Surgical utilization review.

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution
• Paid holidays
• Paid Time Off
• Medical, dental, vision benefits
• Short and long term disability benefits
• Life insurance
• Wellness programs
• Financial education resources