Clinical Operations Associate Medical Director - AIM - Rehab and Physical Medicine

Role Details

Clinical Operations Associate Medical Director - AIM - Rehab and Physical Medicine

• Job Family: Medical and Clinical

• Type: Full time

• Date Posted:Feb 16, 2023

• Req #: JR55033

Location:

• California, California

• National +50 Miles away from nearest PulsePoint, National +50 Miles away from nearest PulsePoint

Description

Clinical Operations Associate Medical Director

Physical Medicine and Rehab

AIM Carelon Insights

AIM Specialty Health is a benefit-management leader in Illinois and a proud member of Elevance Health's family of companies. Our platform delivers significant cost-of-care savings across an expanding set of clinical domains, including radiology, cardiology and oncology.

Job Summary:

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.

• Conduct peer-to-peer consultations with ordering physicians, physician assistants and advanced practice nurses regarding established guidelines and accepted standards of care as it relates to rehabilitative therapeutic services and appropriate sites of service.

• Discuss clinically appropriate alternative treatments and sites of care with ordering providers when consistent with applicable clinical criteria.

• Provide education regarding applicable clinical criteria.

• Provide support and educate internal clinical and non-clinical staff to foster understanding of the principles associated with appropriate therapeutic services and management.

• Participate in physician team meetings.

• Participate in groups that develop, revise, and enhance clinical appropriateness guidelines.

Desired Skills and Abilities:

• Requires an MD

• Board certification in a medical specialty required. American Board of Physician Medicine and Rehab strongly preferred.

For candidates working in person or remotely in the below locations, the salary* range for this specific position is $140,044 to $280,076.

Locations: California; Colorado; Nevada; Washington State; Jersey City, NJ; New York City, NY; Ithaca, NY and Westchester County, NY

In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the company. The company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws .

• The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.

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.ElevanceHealth.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

• Know Your Rights

• 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

Elevance Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.