Medical Director – Genetic Testing, Oncology

Elevance Health

Medical Director overseeing genetic testing utilization reviews in oncology. Responsible for physician consultations and clinical criteria education within the organization.

Posted 5/13/2026full-timeNashville • California, Illinois, Maryland, Massachusetts, New York, Ohio, Tennessee, Virginia • 🇺🇸 United StatesLead💰 $291,200 - $393,120 per yearWebsite

About the role

Key responsibilities & impact

Determines the medical necessity of requests using clinical criteria
Performs physician-level case review of oncologic utilization requests
Conducts peer-to-peer consultation with ordering physicians, physician assistants and advanced practice nurses regarding established guidelines and accepted standards of care as it relates to treatments, procedures, imaging and appropriate sites of service
Provides education regarding applicable clinical criteria and discusses clinically appropriate options
Performs first level provider appeals for coverage decisions
Provides support and education to internal clinical and non-clinical staff regarding the principles associated with appropriate diagnoses, treatments, and management related to these specialties
Participates in physician team meetings
Participates in groups that develop, revise and enhance clinical appropriateness guidelines

Requirements

What you’ll need

Requires MD and/or DO
completion of training in Oncology, or related board certification by either the American Board of Medical Specialties or the American Osteopathic Association Specialties
Requires a current, valid, active and unrestricted medical license(s) as a Doctor of Medicine or Doctor of Osteopathic Medicine in appropriate state(s)
Requires a minimum of 5 years of clinical experience
Experience with utilization management, especially with CMS guidelines preferred

Benefits

Comp & perks

comprehensive benefits package
incentive and recognition programs
equity stock purchase
401k contribution
paid holidays
Paid Time Off
medical
dental
vision
short and long term disability benefits
wellness programs
financial education resources

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

clinical criteriaoncologic utilization reviewpeer-to-peer consultationprovider appealsdiagnosis managementtreatment managementclinical appropriateness guidelinesutilization managementCMS guidelines

Soft Skills

educationcommunicationcollaborationsupportteam participation

Certifications

MDDOboard certification in OncologyAmerican Board of Medical SpecialtiesAmerican Osteopathic Association Specialties