Medical Director – Surgery

Elevance Health

Medical Director focused on surgical procedures and quality improvement at Elevance Health. Conducts case reviews and peer consultations while ensuring compliance with clinical guidelines.

Posted 5/29/2026full-timeLouisville • Kentucky, Tennessee, Wisconsin • 🇺🇸 United StatesLeadWebsite

About the role

Key responsibilities & impact

Determines the medical necessity of requests using clinical criteria
Performs physician-level case review of surgical 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 interventional and non-interventional 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 of conditions and surgical procedures
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 General Surgery, Surgical Subspecialties, or specialties that perform interventional procedures
Requires 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.

Benefits

Comp & perks

merit increases
paid holidays
Paid Time Off
incentive bonus programs (unless covered by a collective bargaining agreement)
medical
dental
vision
short and long term disability benefits
401(k) +match
stock purchase plan
life insurance
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 criteria determinationphysician-level case reviewpeer-to-peer consultationsurgical utilization requestsprovider appealsdiagnosis managementtreatment managementsurgical procedures managementclinical appropriateness guidelines

Soft Skills

educationcommunicationcollaborationteam participationsupport

Certifications

MDDOboard certificationAmerican Board of Medical SpecialtiesAmerican Osteopathic Association Specialties