Clinical Ops Associate Medical Director at Elevance Health in Brentwood, Tennessee

Job Description:

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:


1. Ensures timely completion of clinical case reviews for post-acute care.


2. Makes physician to physician calls to gather medical appropriate information in order to make medical necessity determinations for services requested.


3. Makes medical necessity determinations for grievance and appeals appropriate for their specialty.


4. Ensures consistent use of medical policies when making medical necessity decisions.


5. Brings to their supervisor's attention, any case review decisions that require Medical Director review or policy interpretation.


Requires an MD or DO and board certification in a medical specialty. This job is paid on an hourly basis.