Elevance Health

The Medical Director Associate is responsible for providing day-to-day guidance, support, and leadership for clinical and/or quality activities under the guidance of a Medical Director. May be responsible for supporting one or more Medical Directors in ensuring clinical integrity of broad and significant clinical programs. May perform clinical review. This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. Responsibilities include providing clinical guidance for programs, supporting clinicians to ensure timely and consistent responses to members and providers, conducting peer-to-peer clinical reviews and appeal case reviews with attending physicians or other ordering providers, participating in a physician on-call rotation for a 24x7 unit, assisting in practitioner appeal reviews, appropriateness criteria reviews, medical technology assessments, setting and implementing QI initiatives, and practitioner/provider credentialing. May be responsible for administration of medical services for company health plans including medical policies, serving as a resource and consultant to other areas of the company, interpreting existing medical policy, and representing the company to external entities and/or serving on internal and/or external committees. Requires MD or DO and Board certification approved by ABMS or AOA, active unrestricted medical license, minimum of 5 years clinical experience or equivalent, and must be located in a US state or territory when conducting utilization review or appeals consideration.