Regional Medical Director overseeing clinical strategy for Crossover Health in the Bay Area. Focus on improving patient engagement, quality, and overall health services strategy.
About the role
- Appeals Medical Director for Oncology reviewing appeals for physical health services at Elevance Health. Overseeing clinical consultations and guiding process improvements for care quality and costs.
Responsibilities
- Responsible for the appeal reviews for physical health medical services
- Supports clinicians to ensure timely and consistent responses to members and providers
- Provides guidance for clinical operational aspects of a program
- May conduct peer-to-peer clinical case reviews with attending physicians or other ordering providers
- Serves as a resource and consultant for other areas of the company
- Interprets medical policies and clinical guidelines
- Leads, develops, directs, and implements clinical and non-clinical activities that impact health care quality cost and outcomes
Requirements
- Requires MD or DO and Board certification approved by ABMS or AOA
- Must possess an active unrestricted medical license to practice medicine
- Minimum of 10 years of clinical experience
- For Health Solutions and Carelon organizations, minimum of 5 years of experience providing healthcare is required
- Board certification in Oncology or Hematology and Oncology strongly preferred
- Utilization Management or Appeals experience preferred
Benefits
- Comprehensive benefits package
- Incentive and recognition programs
- Equity stock purchase
- 401k contribution
- Paid holidays
- Paid Time Off
- Medical benefits
- Dental benefits
- Vision benefits
- Short and long term disability benefits
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