Medical Director, Cardiology
Elevance Health
full-time
Posted on:
Location Type: Remote
Location: Remote • District of Columbia, Florida, Illinois, New York • 🇺🇸 United States
Visit company websiteSalary
💰 $215,255 - $352,236 per year
Job Level
Lead
About the role
- Support medical management staff ensuring timely and consistent medical decisions to members and providers
- Participate in pre-authorization and quality improvement solutions for specialized cardiology and vascular surgery
- Ensure timely completion of clinical case reviews for board certified specialty
- Make physician-to-physician calls to gather clinically appropriate information for medical necessity determinations
- Make medical necessity determinations for grievance and appeals appropriate for specialty
- Ensure consistent use of company medical policies when making medical necessity decisions
- Escalate case review decisions that require Medical Director review or policy interpretation to supervisors
- Determine medical necessity using applicable clinical criteria (AIM Appropriateness Guidelines, client-specific health plan medical policy, evidence-based guidelines, state mandates, CMS Coverage Determinations)
- Perform physician-level case review for cardiac procedures, percutaneous interventions, implanted cardiac devices, electrophysiology procedures, and arterial/venous endovascular interventions
- Conduct peer-to-peer consultations with ordering physicians, physician assistants and advanced practice nurses regarding guidelines and standards of care
- Discuss clinically appropriate alternative treatments, imaging studies and sites of care with ordering providers
- Provide education regarding applicable clinical criteria
Requirements
- Requires MD or DO
- Board certification approved by American Board of Medical Specialties (ABMS) or American Osteopathic Association (AOA) where applicable
- 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 (the 1-year requirement waived for Cardiology, Oncology, and Interventional Pain specialties)
- Board certification in a medical specialty required
- Preferred: Board Certification in Cardiovascular Disease, Interventional Radiology or Vascular Surgery by the American Board of Internal Medicine or Surgery
- Preferred: 3-5 years of clinical practice experience past fellowship training desirable
- Demonstrated knowledge of current practice standards in Vascular surgery or Cardiology
- May require COVID-19 and Influenza vaccination for certain patient/member-facing roles
Benefits
- Comprehensive benefits package
- Incentive and recognition programs
- Equity stock purchase and 401k contribution
- Merit increases
- Paid holidays
- Paid Time Off
- Incentive bonus programs
- Medical, dental, vision benefits
- Short and long term disability benefits
- 401(k) +match
- Stock purchase plan
- Life insurance
- Wellness programs and financial education resources
- Ability to work virtually full-time (Carelon MBM Virtual) with required in-person training
- Hybrid workforce flexibility (onsite attendance may be required)
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
clinical case reviewsmedical necessity determinationspre-authorizationquality improvement solutionscardiac procedurespercutaneous interventionsimplanted cardiac deviceselectrophysiology proceduresendovascular interventionspeer-to-peer consultations
Soft skills
communicationinterpersonal skillsdecision makingproblem solvingeducation
Certifications
MDDOboard certification by ABMSboard certification by AOAactive unrestricted medical licenseboard certification in Cardiovascular Diseaseboard certification in Interventional Radiologyboard certification in Vascular Surgery