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Medical Director – Post Acute Care
Elevance Health. Support medical management staff by ensuring timely and consistent medical decisions for members and providers .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in clinical case reviews and medical necessity determinations, supported by board certification and an active medical license. Strong communication skills are essential for conducting physician-to-physician calls and collaborating with medical management staff.
Highest-signal resume keywords
MD/DOBoard CertificationClinical Case ReviewsMedical Necessity DeterminationsActive Unrestricted Medical License
ATS Keywords
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Hard Skills
Clinical Case ReviewsMedical Necessity DeterminationsMedical Policy ApplicationGrievance and Appeal ManagementPhysician-to-Physician Communication
Soft Skills
CollaborationCommunication
Certifications & Qualifications
Board Certification in Medical SpecialtyBoard Certification in Physical Medicine and Rehab (Preferred)
Industry Keywords
American Board of Medical SpecialtiesAmerican Osteopathic AssociationCOVID-19 VaccinationInfluenza Vaccination
About the role
Key responsibilities & impact- Support medical management staff by ensuring timely and consistent medical decisions for members and providers
- Complete clinical case reviews for the applicable board-certified specialty
- Conduct physician-to-physician calls to gather medically appropriate information for medical necessity determinations
- Make medical necessity determinations for grievances and appeals within the applicable specialty
- Apply company medical policies consistently when making medical necessity decisions
- Escalate case review decisions requiring Medical Director review or policy interpretation to supervisors
Requirements
What you’ll need- MD/DO required
- Board certification in a medical specialty required
- Board certification approved by the American Board of Medical Specialties (ABMS) or American Osteopathic Association (AOA), where applicable
- Active unrestricted medical license to practice medicine or a health profession
- Minimum of 1 year of experience with clinical case reviews for medical necessity; waived for Cardiology, Oncology, and Interventional Pain specialties
- Board certification in Physical Medicine and Rehab preferred
- Candidates must reside within a reasonable commuting distance of the posting location(s), unless an accommodation is granted as required by law
- Candidates in certain patient/member-facing roles must become vaccinated against COVID-19 and Influenza, unless an acceptable explanation is provided
Benefits
Comp & perks- $10,000 sign-on bonus
- Part-time options with at least one weekend day per week
- Virtual full-time work, except for required in-person training sessions
- Paid holidays
- Paid Time Off
- Incentive bonus programs
- Medical insurance
- Dental insurance
- Vision insurance
- Short-term disability benefits
- Long-term disability benefits
- 401(k) match
- Stock purchase plan
- Life insurance
- Wellness programs
- Financial education resources
- Merit increases