Associate Medical Director, Clinical Operations (Surgery)

$203,507 - $203,507/Yr

Elevance Health - Cerritos, CA

Full-time - Senior

Remote - Cerritos, CA

Insurance Carriers and Related Activities

About the position

The Associate Medical Director, Clinical Operations (Surgery) at Elevance Health is responsible for overseeing the medical management staff and ensuring timely and consistent medical decisions regarding surgical procedures. This role involves determining the medical necessity of requests, conducting peer-to-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 applicable clinical criteria and relevant policies.
• 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.

Requirements

• Doctor of Medicine (MD) or Doctor of Osteopathy (DO) degree.
• Board certification in a medical specialty, preferably in General Surgery or other surgical subspecialties.
• 3-5 years of clinical practice experience post-fellowship training is desirable.
• Strong oral communication and interpersonal skills.
• Computer literacy and ability to learn new applications.
• Strong analytical skills and ability to multi-task.

Nice-to-haves

• Current unrestricted medical license(s) in an appropriate state.
• American Board of Medical Specialties board certification in surgical specialties such as ENT, Plastic Surgery, Vascular Surgery, Cardio-thoracic, Trauma, or Transplant.
• Preferred interest in Surgical utilization review.

Benefits

• Employee stock purchase plan
• Paid holidays
• Disability insurance
• Health insurance
• Dental insurance
• 401(k)
• Paid time off
• Vision insurance
• 401(k) matching
• Life insurance