Job ID: JP00043568

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. Previously known as Anthem, Inc., we have evolved into a company focused on whole health and updated our name to better reflect the direction the company is heading.

We are looking for contract workers (via BCforward) who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?

Responsible for the administration of medical services for company health plans including the overall medical policies of the business unit to ensure the appropriate and most cost effective medical care is received and for the day-to-day management of medical management staff.

Primary duties may include, but are not limited to:

• Interprets existing policies and develops new policies based on changes in the healthcare or medical arena.
• Leads, develops, directs and implements clinical and non-clinical activities that impact health care quality cost and outcomes.
• Identifies and develops opportunities for innovation to increase effectiveness and quality.
• Serves as a resource and consultant to other areas of the company.
• May chair or serve on company committees, may be required to represent the company to external entities and/or serve on external committees.
• Conduct peer clinical and/or appeal case reviews and peer to peer clinical reviews with attending physicians or other ordering providers to discuss review determinations.
• Provides guidance for clinical operational aspects of the program.
• Supports the medical management staff ensuring timely and consistent responses to members and providers.

Requirements:

• M.D. or D.O.
• Board certification approved by the American Board of Medical Specialties required where applicable to duties being performed.
• Must possess an active unrestricted medical license to practice medicine or a health profession.
• Unless expressly allowed by state or federal law, or regulation, must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US military base, vessel or any embassy located in or outside of the US.
• 10 years of clinical experience or any combination of education and experience, which would provide an equivalent background.

Additional Details:

• Remote work opportunity.
• 8-5 Monday through Friday.
• Works in UM and Appeals.

BCForward is An Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status and will not be discriminated against on the basis of disability.

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