Medical Director (US)

Medical Director (US)Job Family: Medical and ClinicalType: Full timeDate Posted:Aug 22, 2022Req : JR13790Location:National +50 Miles away from nearest PulsePoint, National +50 Miles away from nearest PulsePointDescriptionJR13790 Medical Director[Position can work from anywhere in the US, but will support all US markets/time zones]We are hiring for a Cardiology Medical Director - Appeals. This role is responsible for the administration of medical services, to ensure the appropriate and most cost-effective medical care is received.How will you make an impact:Appeal ReviewsInterprets medical policies and clinical guidelines. May be responsible for developing and implementing programs to improve quality, cost, and outcomes.Provides clinical consultation and serves as clinical/strategic advisor to enhance clinical operations.Identifies cost of care opportunities.May be responsible for an entire clinical program.Appeals ReviewsSupports clinicians to ensure timely and consistent responses to members and providers.Provides guidance for clinical operational aspects of a program.Serves as a resource and consultant to other areas of the company.May be required to represent the company to external entities and/or serve on internal and/or external committees.May chair company terprets medical policies and clinical guidelines.May develop and propose new medical policies based on changes in healthcare.Leads, develops, directs, and implements clinical and non-clinical activities that impact health care quality cost, and outcomes.Identifies and develops opportunities for innovation to increase effectiveness and quality.Minimum requirements:Requires M.D. or D.OActive board certification approved by the American Board of Medical Specialties requiredPreferred Skills, Capabilities, and Experiences:Must possess an active unrestricted medical license to practice medicine or a health profession. Unless expressly allowed by state or federal law or regulation, must be located in a state or territory of the United States when conducting a utilization review or an appeals consideration and cannot be located on a US military base, vessel, or any embassy located in or outside of the US, and 10 years of clinical experience or any combination of education and experience, which would provide an equivalent background.Colorado candidates onlyAnnual Salary Range*: 224,000.00 - 336,000.00 USDActual compensation may vary from posting based on geographic location, work experience, education, and/or skill level.The hourly or salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. The Company may ultimately pay more or less than the posted range. This range is only applicable for jobs to be performed in Colorado. This range may be modified in the future. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits or any other form of compensation and benefits that are allocable to a particular employee remains in the Company''s sole discretion unless and until paid and may be modified at the Companys sole discretion, consistent with the law.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 TeamElevance Health is a health company dedicated to improving lives and communities and making healthcare simpler. Previously known as Anthem, Inc., we have evolved into a company focused on whole health and updated our name to better reflect the direction the company is heading.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 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 2021, is ranked as one of the 2021 Worlds Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at . 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 [Click Here to Email Your Resumé] for assistance.EEO is the LawEqual Opportunity Employer / Disability / VeteranPlease use the links below to review statements of protection from discrimination under Federal law for job applicants and employees.EEO Policy StatementEEO is the Law PosteroEEO Poster Supplement-English VersionPay TransparencyPrivacy Notice for California ResidentsElevance Health, Inc. is an E-verify EmployerNeed Assistance?Email us [Click Here to Email Your Resumé]) or call 1-877-204-7664

Created: 2025-10-04