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Elevance HealthCore Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates extensive clinical expertise with a focus on improving healthcare quality, cost, and outcomes through strategic program development and implementation. Provides clinical consultation and operational guidance while ensuring compliance with medical policies and guidelines.
Highest-signal resume keywords
MD/DO RequiredBoard Certification Approved By ABMS Or AOAActive Unrestricted Medical LicenseMinimum Of 10 Years Of Clinical ExperienceUtilization Management Experience
About the role
Key responsibilities & impact- Administer medical services to ensure appropriate and cost-effective medical care
- Develop and implement programs improving quality, cost, and outcomes
- Provide clinical consultation and strategic advice to enhance clinical operations
- Identify cost-of-care opportunities
- Serve as a resource to staff, including Medical Director Associates
- Support clinicians in providing timely and consistent responses to members and providers
- Guide clinical operational aspects of programs
- Conduct peer-to-peer clinical reviews with attending physicians and other providers
- Serve as a resource and consultant to other company areas
- Represent the company to external entities and serve on internal or external committees
- Chair company committees
- Interpret medical policies and clinical guidelines
- Develop and propose new medical policies based on healthcare changes
- Lead, develop, direct, and implement clinical and non-clinical activities affecting healthcare quality, cost, and outcomes
- Identify and develop innovation opportunities to increase effectiveness and quality
- Provide evening and weekend coverage on an equal rotation
Requirements
What you’ll need- MD/DO required
- Board certification approved by ABMS or AOA, where applicable to duties performed
- Active unrestricted medical license to practice medicine or a health profession
- Must be located in a state or territory of the United States when conducting utilization review or appeals consideration, unless expressly allowed by law or regulation
- Minimum of 10 years of clinical experience
- Additional state licensing or willingness to obtain
- Previous experience in utilization management preferred
- Experience with MCG, Carelon, and Anthem criteria helpful
- Oncology and genetic testing specialty review experience
- Musculoskeletal review experience
- Evening and weekend coverage on an equal rotation
- Any combination of education and experience providing an equivalent background
Benefits
Comp & perks- Comprehensive benefits package
- Incentive and recognition programs
- Equity stock purchase
- 401(k) contribution and match
- Merit increases
- Paid holidays
- Paid Time Off
- Incentive bonus programs
- Medical, dental, and vision benefits
- Short- and long-term disability benefits
- Stock purchase plan
- Life insurance
- Wellness programs
- Financial education resources
- Virtual work flexibility
- Required in-person training sessions
- COVID-19 and Influenza vaccination coverage/requirement for certain patient/member-facing roles
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Clinical ConsultationProgram DevelopmentCost-Of-Care IdentificationPeer-To-Peer Clinical ReviewsOncology Review ExperienceGenetic Testing Review ExperienceMusculoskeletal Review Experience
Soft Skills
Strategic AdviceResourcefulnessLeadershipCollaboration
Tools & Technologies
MCG CriteriaCarelonAnthem Criteria
Certifications & Qualifications
Board CertificationActive Medical License
Industry Keywords
Healthcare QualityCost ManagementClinical OperationsMedical PoliciesUtilization Review