Medical Director – Physical Medicine and Rehabilitation

Elevance Health

. Evaluate high-cost Durable Medical Equipment (DME) requests for appropriateness, particularly within a Medicaid context .

Posted 11/2/2026full-timeAtlanta • United StatesLeadWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in evaluating Durable Medical Equipment (DME) requests and conducting clinical reviews, with a strong focus on Medicaid compliance and healthcare quality improvement. Possesses extensive clinical experience and leadership capabilities in developing medical policies and collaborating across multidisciplinary teams.

Highest-signal resume keywords

MD Or DOBoard CertificationActive Unrestricted Medical LicenseUtilization Management ExperienceDurable Medical Equipment Experience

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Clinical ReviewPeer-To-Peer ReviewMedical Policy InterpretationHealthcare Quality ImprovementClinical Operations Guidance

Soft Skills

CollaborationConsultationLeadership

Certifications & Qualifications

Board Certification Approved By ABMS Or AOA

Industry Keywords

Durable Medical EquipmentMedicaidHealthcare ComplianceClinical GuidelinesHealth Care Quality

About the role

Key responsibilities & impact

Evaluate high-cost Durable Medical Equipment (DME) requests for appropriateness, particularly within a Medicaid context
Support clinicians in providing timely and consistent responses to members and providers
Provide guidance on clinical operational aspects of programs
Conduct peer-to-peer clinical reviews with attending physicians and other providers regarding review determinations and patient office visits
Conduct peer-to-peer clinical appeal case reviews when required
Serve as a resource and consultant for other company areas
Represent the company to external entities and serve on internal or external committees when required
Chair company committees when required
Interpret medical policies and clinical guidelines
Develop and propose new medical policies based on changes in healthcare
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
Collaborate cross-functionally with a small, distributed team operating across multiple states

Requirements

What you’ll need

MD or DO required
Board certification approved by the American Board of Medical Specialties (ABMS) or American Osteopathic Association (AOA), where applicable to duties being 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 an appeals consideration, unless expressly allowed by state or federal law or regulation
Cannot be located on a US military base, vessel, or embassy located in or outside of the US when conducting utilization review or appeals consideration
Minimum of 10 years of clinical experience, or an equivalent combination of education and experience
For Health Solutions and Carelon organizations, minimum of 5 years of experience providing health care
Additional experience may be required by state contracts or regulations
Utilization management experience preferred
Durable Medical Equipment (DME) experience preferred
Board certification in Physical Medicine and Rehabilitation strongly preferred

Benefits

Comp & perks

Merit increases
Paid holidays
Paid Time Off
Incentive bonus programs
Medical benefits
Dental benefits
Vision benefits
Short-term disability benefits
Long-term disability benefits
401(k) with company match
Stock purchase plan
Life insurance
Wellness programs
Financial education resources
Virtual full-time work arrangement, except for required in-person training sessions