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Elevance Health Clinical Operations Associate Medical Director in Woodland Hills, California

Clinical Operations Associate Medical Director

  • Job Family: Medical and Clinical

  • Type: Full time

  • Date Posted:Jul 06, 2022

  • Req #: JR4364

Location:

  • Illinois, Chicago

  • IL, Springfield

  • IL, Chicago

  • CA, Downey

  • MA, Boston

  • IN, Indianapolis

  • Georgia, Atlanta

  • CA, Apple Valley

  • MA, Boston

  • MA, Boston

  • Georgia, Georgia

  • MA, NEW BEDFORD

  • MA, Watertown

  • MA, Boston

  • MA, Boston

  • IN, Evansville

  • MA, Hingham

  • MA, Quincy

  • GA, Atlanta

  • CA, Alhambra

  • GA, Atlanta

  • CA, Fullerton

  • IL, Deerfield

  • GA, Atlanta

  • CA, Cerritos

  • GA, Atlanta

  • CA, Cerritos

  • CA, Downey

  • GA, Atlanta

  • Tennessee, Tennessee

  • IL, Chicago

  • IL, Schaumburg

  • MA, Andover

  • GA, Atlanta

  • IN, Indianapolis

  • CA, Gilroy

  • IL, Springfield

  • CA, Downey

  • IN, Indianapolis

  • IN, Indianapolis

  • MA, Worcester

  • IL, Westchester

  • CA, Costa Mesa

  • GA, Atlanta

  • CA, Cypress

  • MA, Springfield

  • CA, Brea

  • CA, Cerritos

  • Massachusetts, Massachusetts

  • IL, Chicago

  • IL, Chicago

  • Illinois, Illinois

  • California, California

  • GA, Atlanta

  • IL, Chicago

  • CA, Apple Valley

  • MA, Woburn

  • MA, Newton 55 Chapel Bridge Park

  • IL, Chicago

  • MA, Boston

Description

Clinical Operations Associate Medical Director

AIM

Remote

Job Summary:

Responsible for supporting the medical management staff ensuring timely and consistent medical decisions to members and providers. Primarily focusing on case review of imaging/radiology utilization management.

Primary Duties and Responsibilities:

  • Perform physician-level case review, following initial nurse review, of high-tech diagnostic imaging. Imaging modalities include CT, CTA, MRI, MRA, PET, and Nuclear Cardiology.

  • Determine medical necessity of requests using AIM Medical Necessity Guidelines and client-specific health plan medical policy.

  • Conduct peer-to-peer discussions with ordering physicians, physician assistants, and nurse practitioners to provide education regarding established guidelines and accepted standards of care as they pertain to the use of diagnostic imaging studies, cardiac testing and sleep management services.

  • Suggest alternatives services to ordering providers when appropriate.

  • Document the pre-certification review in a complete, concise, and accurate manner in the pre-certification computer application.

  • Demonstrate and maintain current knowledge of modalities and new applications of known technologies for diagnostic imaging, cardiac services and sleep management.

  • As necessary, assist pre-certification nurses and other staff in understanding the principles behind appropriate utilization of covered modalities.

  • Participate in periodic physician team meetings.

  • Demonstrate and maintain knowledge of relevant policies and regulations pertaining to utilization review of diagnostic imaging procedures, cardiac services and sleep management.

  • Participate on committees or in work groups as needed for revision of clinical guidelines and/or serve as a subject matter expert.

  • Perform first level provider appeals as designated by the client for adverse determinations.

  • Obtain additional state licensure based upon business needs.

  • Adhere to all AIM Specialty Health Management protocols, policies, and procedures.

Minimum Requirements:

  • Requires an MD and Board certification in a medical specialty required.

Preferred Qualifications

  • Strong oral communication and interpersonal skills

  • Computer literacy with the ability to learn new applications

  • Strong analytical skills

  • Ability to multi-task

  • Ability to work both independently and in a team environment

  • Ability to work in a dynamic, fast-paced environment

Please be advised that Elevance Health only accepts resumes from agencies that have a signed agreement with Elevance Health. Accordingly, Elevance Health is not obligated to pay referral fees to any agency that is not a party to an agreement with Elevance Health. Thus, any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Be part of an Extraordinary Team

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 leaders at all levels of the organization 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?

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and 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 and financial education resources, to name a few.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide – and Elevance Health approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Elevance Health is able to reasonably accommodate. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 World’s Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at careers.ElevanceHealthinc.com. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ability@icareerhelp.com for assistance.

EEO is the Law

Equal Opportunity Employer / Disability / Veteran

Please use the links below to review statements of protection from discrimination under Federal law for job applicants and employees.

  • EEO Policy Statement

  • EEO is the Law Postero

  • EEO Poster Supplement-English Version

  • Pay Transparency

  • Privacy Notice for California Residents

Elevance Health, Inc. is an E-verify Employer

Need Assistance?

Email us (elevancehealth@icareerhelp.com) or call 1-877-204-7664

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