What are the responsibilities and job description for the Clinical Ops Associate Medical Director position at elevancehealth?
Job ID: JP00046697
Anticipated Start Date: August 10, 2026
Please note this is the target date and is subject to change. BCForward will send official notice ahead of a confirmed start date.
Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
Responsible for supporting the medical management staff ensuring timely and consistent medical decisions to members and providers.
Primary duties may include, but are not limited to:
Ensures timely completion of clinical case reviews for their board-certified specialty.
Makes physician to physician calls to gather medical appropriate information in order to make medical necessity determinations for services requested.
Makes medical necessity determinations for grievance and appeals appropriate for their specialty.
Ensures consistent use of medical policies when making medical necessity decisions.
Brings to their supervisors attention, any case review decisions that require Medical Director review or policy interpretation.
Requirements:
Requires MD/DO and Board certification approved by one of the following certifying boards is required, where applicable to duties being performed, American Board of Medical Specialties (ABMS) or American Osteopathic Association (AOA).
Must possess an active unrestricted medical license to practice medicine or a health profession.
Job Type: Contract
Additional Details:
Microsoft Office Suite experience.
Exposure to ordering and reviewing outpatient Physical therapy, Occupational therapy, and Speech therapy.
Work hours: Monday-Friday, 9:00am-5:30pm in your time zone.
Will consider 33-40 hours per week.
Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.
Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, contractors are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.
About BCForward:
Founded in 1998 on the idea that industry leaders needed a professional service, and workforce management expert, to fuel the development and execution of core business and technology strategies, BCforward is a Black-owned firm providing unique solutions supporting value capture and digital product delivery needs for organizations around the world. Headquartered in Indianapolis, IN with an Offshore Development Center in Hyderabad, India, BCforward's 6,000 consultants support more than 225 clients globally.
BCforward champions the power of human potential to help companies transform, accelerate, and scale. Guided by our core values of People-Centric, Optimism, Excellence, Diversity, and Accountability, our professionals have helped our clients achieve their strategic goals for more than 25 years. Our strong culture and clear values have enabled BCforward to become a market leader and best in class place to work.
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 based on disability.
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