Medical Oncology Medical Director
Company: Elevance Health
Location: Sacramento
Posted on: May 28, 2023
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Job Description:
Medical Oncology Medical Director
Job Family: Medical and Clinical
Type: Full time
Date Posted:May 23, 2023
Req #: JR72583
Location:
Indiana, Indiana
National +50 Miles away from nearest PulsePoint, National +50 Miles
away from nearest PulsePoint
Description
Clinical Operations Medical Director
Utilization Management of Medical Oncology Benefits
Carelon Benefits Management (AIM)
$20,000 Sign On Bonus
Remote/Work From Home - Location flexible within the United
States
A proud member of the Elevance Health family of companies, Carelon
Medical Benefits Management, formerly AIM Specialty Health, is a
benefit-management leader in Illinois. Our platform delivers
significant cost-of-care savings across an expanding set of
clinical domains, including radiology, cardiology and oncology.
The Clinical Operations Medical Director is responsible for
supporting the medical management staff ensuring timely and
consistent medical decisions to members and providers.
Job Summary:
Perform physician-level case review, following initial nurse
review, of radiation therapy regimens and supportive care.
Perform physician-level case review, following initial nurse
review, of high-tech diagnostic imaging. Imaging modalities include
CT, CTA, MRI, MRA, and PET.
Determine medical necessity of requests using AIM Medical Necessity
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.
As necessary, 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 AIM Specialty Health Management protocols, policies,
and procedures.
Minimum Requirements:
Requires an MD and minimum of 1 year of experience with clinical
case reviews for medical necessity. The minimum of 1 year of
experience with clinical case reviews would be waived for the
following specific specialties only; Cardiology, Oncology, and
Interventional Pain specialties.
Board certification in a medical specialty required.
--------------------- Preferred Qualifications:
3-5 years of clinical practice experience past fellowship training
is desirable.
Demonstrated knowledge of current practice standards in
oncology.
Strong oral communication and interpersonal skills.
Intermediate computer skills (including MS Office and Outlook),
ability to learn new applications.
Strong analytical skills.
Ability to multi-task.
Ability to work both independently and in a team environment.
Ability to work in a dynamic, fast-paced environment.
For candidates working in person or remotely in the below
locations, the salary* range for this specific position is $181,750
to $327,176.
Locations: California; Colorado; Nevada; Washington State; Jersey
City, NJ; New York City, NY; Ithaca, NY and Westchester County,
NY
In addition to your salary, Elevance Health offers benefits such
as, a comprehensive benefits package, incentive and recognition
programs, equity stock purchase and 401k contribution (all benefits
are subject to eligibility requirements). The salary offered for
this specific position is based on a number of legitimate,
non-discriminatory factors set by the company. The company is fully
committed to ensuring equal pay opportunities for equal work
regardless of gender, race, or any other category protected by
federal, state, and local pay equity laws .
Please be advised that Elevance Health only accepts resumes from
agencies that have a signed agreement with Elevance Health.
Accordingly, Elevance Health is not obligated to pay referral fees
to any agency that is not a party to an agreement with Elevance
Health. Thus, any unsolicited resumes, including those submitted to
hiring managers, are deemed to be the property of Elevance
Health.
Be part of an Extraordinary Team
Elevance Health is a health company dedicated to improving lives
and communities - and making healthcare simpler. A Fortune 20
company with a longstanding history in the healthcare industry, we
are looking for leaders at all levels of the organization who are
passionate about making an impact on our members and the
communities we serve. You will thrive in a complex and
collaborative environment where you take action and ownership to
solve problems and lead change. Do you want to be part of a larger
purpose and an evolving, high-performance culture that empowers you
to make an impact?
We offer a range of market-competitive total rewards that include
merit increases, paid holidays, Paid Time Off, and incentive bonus
programs (unless covered by a collective bargaining agreement),
medical, dental, vision, short and long term disability benefits,
401(k) +match, stock purchase plan, life insurance, wellness
programs and financial education resources, to name a few.
The health of our associates and communities is a top priority for
Elevance Health. We require all new candidates in certain
patient/member-facing roles to become vaccinated against COVID-19.
If you are not vaccinated, your offer will be rescinded unless you
provide - and Elevance Health approves - a valid religious or
medical explanation as to why you are not able to get vaccinated
that Elevance Health is able to reasonably accommodate. Elevance
Health will also follow all relevant federal, state and local
laws.
Elevance Health has been named as a Fortune Great Place To Work in
2022, has been ranked for five years running as one of the 2023
World's Most Admired Companies by Fortune magazine, and is a
growing Top 20 Fortune 500 Company. To learn more about our company
and apply, please visit us at careers.ElevanceHealth.com. 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. Applicants who require accommodation to
participate in the job application process may contact
ability@icareerhelp.com for assistance.
EEO is the Law
Equal Opportunity Employer / Disability / Veteran
Please use the links below to review statements of protection from
discrimination under Federal law for job applicants and
employees.
EEO Policy Statement
Know Your Rights
Pay Transparency
Privacy Notice for California Residents
Elevance Health, Inc. is anE-verify Employer
(https://www.e-verify.gov/sites/default/files/everify/posters/EVerifyParticipationPoster.pdf)
Need Assistance?
Email us (elevancehealth@icareerhelp.com) or call
1-877-204-7664
Keywords: Elevance Health, Sacramento , Medical Oncology Medical Director, Executive , Sacramento, California
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