Medical Director, Cardiology
Elevance Health
Medical Director – Medical Oncology
Elevance Health
full-time
Posted on:
Location Type: Hybrid
Location: Chicago • Illinois, New Jersey • 🇺🇸 United States
Visit company websiteSalary
💰 $215,255 - $322,883 per year
Job Level
Lead
About the role
- Perform physician-level case review, following initial nurse review, of Medical Oncology regimens and supportive care
- Perform physician-level case review, following initial nurse review, of chemotherapy regimens
- Determine medical necessity of requests using 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
- Assist pre-certification nurses and other staff in understanding appropriate utilization of covered treatments and genetic testing
- Participate in periodic physician team meetings and on committees or work groups as needed
- Maintain knowledge of relevant policies and regulations pertaining to utilization review of oncology care
- Perform first level provider appeals for adverse determinations as designated by the client
- Obtain additional state licensure as needed
- Ensure timely completion of clinical case reviews and consistent use of company medical policies
- Make physician-to-physician calls to gather medically appropriate information and make medical necessity determinations for grievance and appeals
Requirements
- Requires MD or DO and Board certification approved by ABMS or AOA
- Must possess an active unrestricted medical license to practice medicine or a health profession
- Minimum of 1 year of experience with clinical case reviews for medical necessity (waived for Cardiology, Oncology, Interventional Pain specialties)
- Board certification in a medical specialty required
- Preferred: Board Certification in Medical Oncology strongly preferred
- Preferred: 3-5 years of clinical practice experience past fellowship training desirable
- Demonstrated knowledge of current practice standards in oncology
- Ability/requirement to obtain additional state licensure based upon business needs
- Adhere to all company protocols, policies, and procedures
- May be required to be vaccinated against COVID-19 and Influenza for certain patient/member-facing roles
Benefits
- comprehensive benefits package
- incentive and recognition programs
- equity stock purchase
- 401k contribution / 401(k) +match
- merit increases
- paid holidays
- Paid Time Off
- incentive bonus programs
- medical, dental, vision
- short and long term disability benefits
- life insurance
- wellness programs and financial education resources
- Virtual full-time with required in-person training (flexible work arrangement)
- Hybrid Workforce Strategy with periodic onsite expectations
ATS Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
clinical case reviewmedical necessity determinationoncology treatment regimenspre-certification reviewgenetic testingpeer-to-peer discussionsprovider appealsutilization reviewdocumentationeducation on oncology care
Soft skills
communicationteam collaborationeducational skillsorganizational skillsattention to detailproblem-solvinginterpersonal skillsleadershipadaptabilitytime management
Certifications
MDDOBoard certificationBoard certification in Medical Oncologyactive unrestricted medical license
