Medical Director – Physician Reviewer
MedReview Inc.
Behavioral Health Medical Director-Psychiatrist Appeals
Elevance Health
full-time
Posted on:
Location: California • 🇺🇸 United States
Visit company websiteSalary
💰 $274,068 - $428,976 per year
Job Level
Lead
About the role
- The Medical Director administers behavioral health medical services to ensure appropriate and cost-effective care
- Develops and implements 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
- Conducts peer-to-peer clinical appeal case reviews with attending physicians or other ordering providers
- Represents the company to external entities and/or serves on internal/external committees
- Chairs company committees as needed
- Interprets medical policies and clinical guidelines
- Develops and proposes new medical policies based on changes in healthcare
- Leads and manages clinical and non-clinical activities affecting health care quality, cost, and outcomes
- Identifies opportunities for innovation to increase effectiveness
- Provides oversight to Medical Director Associates
- Works independently with oversight from immediate manager
- May be responsible for an entire clinical program; may perform clinical reviews
- Typically has program management responsibilities including clinical policy development and program implementation
Requirements
- MD or DO and Board certification approved by ABMS or AOA
- Active unrestricted medical license to practice medicine or a health profession in California
- Must be located in a state or territory of the United States when conducting utilization review or an appeals consideration; cannot be located on a US military base, vessel or any embassy located in or outside of the US
- Minimum of 10 years of clinical experience; or any combination of education and experience providing an equivalent background
- For Health Solutions and Carelon organizations (including Behavioral Health) only, minimum of 5 years of experience providing health care is required
- Additional experience may be required by State contracts or regulations if the Medical Director is filing a role required by State agency
