Appeals Medical Director – Urology

Elevance Health

Appeals Medical Director overseeing appeal reviews for physical health services at Elevance Health. Developing programs to enhance quality, cost, and outcomes while providing clinical consultation.

Posted 5/21/2026full-timeCalifornia, Maryland, Ohio, Virginia • 🇺🇸 United StatesLead💰 $247,840 - $446,112 per yearWebsite

About the role

Key responsibilities & impact

Responsible for appeal reviews for physical health medical services
Ensure appropriate and cost-effective medical care is received
May develop and implement programs to improve quality, cost, and outcomes
Provide clinical consultation and serve as clinical/strategic advisor
Identify cost of care opportunities
Supports clinicians for timely and consistent responses to members and providers
Provides guidance for clinical operational aspects of a program
Conduct peer-to-peer clinical case reviews
Serves as a resource and consultant for other areas of the company
May represent the company to external entities and serve on committees
Interprets medical policies and clinical guidelines
May develop and propose new medical policies
Leads, develops, directs, and implements clinical and non-clinical activities

Requirements

What you’ll need

Requires MD or DO
Board certification approved by ABMS or AOA
Must possess an active unrestricted medical license
Minimum of 10 years clinical experience
For Health Solutions and Carelon, minimum of 5 years experience providing health care is required
Additional experience may be required by State contracts or regulations

Benefits

Comp & perks

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

ATS Keywords

✓ Tailor your resume

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills & Tools

clinical consultationpeer-to-peer clinical case reviewsmedical policy interpretationprogram developmentquality improvementcost managementclinical guidelinesstrategic advisingclinical operationshealth care delivery

Soft Skills

leadershipcommunicationconsultationadvisorycollaborationproblem-solvingorganizational skillsresourcefulnesstimelinessstrategic thinking

Certifications

MDDOboard certificationactive unrestricted medical license