Job Information
Elevance Health Oncology/Radiation Oncology - Clinical Operations Medical Director - Utilization Review in Richmond, Virginia
Oncology/Radiation Oncology - Clinical Operations Medical Director - Utilization Review
Job Family: Medical and Clinical
Type: Full time
Date Posted:Aug 03, 2022
Req #: PS74928
Location:
CA, Los Angeles
CA, Downey
Texas, Texas
IN, Indianapolis
CA, Monterey Park
Georgia, Georgia
CA, Foothills Ranch
IN, Columbus
CA, San Jose
CA, Redondo Beach
Arkansas, Arkansas
PA, Philadelphia
New Jersey, New Jersey
CA, Los Angeles
CA, San Francisco
CA, El Segundo
CA, San Francisco
Montana, Montana
GA, Atlanta
Alabama, Alabama
CA, Norwalk
CA, Lancaster
GA, Atlanta
CA, Whittier
CA, San Jose
CA, El Segundo
CA, Alameda
GA, Atlanta
CA, Cerritos
GA, Atlanta
IN, Bedford
CA, San Francisco
Tennessee, Tennessee
CA, Walnut Creek
Washington, Washington
IL, Chicago
CA, Camarillo
CA, San Francisco
CA, San Francisco
CA, Thousand Oaks
CA, Oakland
CA, Visalia
IN, Indianapolis
CA, French Camp
Florida, Florida
CA, Los Angeles
CA, Cypress
CA, Newbury Park
CA, Brea
CA, Orange
CA, Los Angeles
IL, Chicago
Pennsylvania, Pennsylvania
Oregon, Oregon
IL, Chicago
IL, Chicago
CA, Pico Rivera
CA, Eureka
GA, Atlanta
CA, Los Angeles
CA, Apple Valley
CA, Santa Ana
CA, Fairfield
CA, Scotts Valley
CA, Modesto
Ohio, Ohio
CA, Hollister
CA, San Francisco
CA, Rancho Cordova
CA, Santa Clara
CA, San Jose
CA, Mountain View
CA, Milpitas
CA, Oakdale
IN, Evansville
CA, Los Angeles
CA, Thousand Oaks
CA, Placentia
CA, Irvine
CA, Santa Ana
GA, Atlanta
CA, Alhambra
CA, Fullerton
GA, Loganville
CA, Turlock
CA, Upland
CA, Whittier
CA, West Covina
CA, Cerritos
CA, La Habra
CA, Lawndale
CA, La Mirada
CA, Woodland Hills
CA, Modesto
CA, Downey
CA, San Jose
Virginia, Virginia
CA, La Mirada
CA, Glendale
CA, Long Beach
GA, Loganville
CA, Placentia
CA, Glendale
GA, Atlanta
CA, Norwalk
CA, Gilroy
IN, Indianapolis
CA, Pico Rivera
CA, Hacienda Heights
CA, San Diego
IN, Indianapolis
CA, Long Beach
CA, Montebello
New York, New York
CA, San Jose
CA, Huntington Beach
CA, Long Beach
GA, Atlanta
New Mexico, New Mexico
CA, Costa Mesa
CA, Montebello
CA, Cerritos
IL, Chicago
CA, Los Angeles
CA, Pasadena
CA, Whittier
IL, Chicago
Illinois, Illinois
CA, Palo Alto
Idaho, Idaho
GA, Atlanta
CA, Apple Valley
Description
Medical Director -Utilization Management of Oncology Benefits
AIM Specialty Health
Location: This position has been approved to work remote, anywhere in the US with preference given to candidates located in California.
Job Summary:
Perform physician-level case review, following initial nurse review, of radiation therapy regimens and supportive care.
Perform physician-level case review, following initial nurse review, of high-tech diagnostic imaging. Imaging modalities include CT, CTA, MRI, MRA, and PET.
Determine medical necessity of requests using AIM Medical Necessity Guidelines and client-specific health plan medical policy.
Conduct peer-to-peer discussions with ordering physicians, physician assistants, and nurse practitioners to provide education regarding established guidelines and accepted standards of oncology care.
Document the pre-certification review in a complete, concise, and accurate manner in the pre-certification computer application.
Demonstrate and maintain current knowledge of new cancer treatment regimens.
As necessary, assist pre-certification nurses and other staff in understanding the principles behind appropriate utilization of covered treatments and genetic testing.
Participate in periodic physician team meetings.
Demonstrate and maintain knowledge of relevant policies and regulations pertaining to utilization review of oncology care.
Participate on committees or in work groups as needed for revision of clinical guidelines and/or serve as a subject matter expert.
Perform first level provider appeals as designated by the client for adverse determinations.
Obtain additional state licensure based upon business needs.
Adhere to all AIM Specialty Health Management protocols, policies, and procedures.
Minimum Requirements:
Current unrestricted medical license(s) as a Doctor of Medicine or Doctor of Osteopathic Medicine
Board Certification by American Board of Medical Specialties in Medical Oncology or Radiation Oncology.
Preferred Qualifications
3-5 years of clinical practice experience past fellowship training is desirable.
Demonstrated knowledge of current practice standards in oncology.
Strong oral communication and interpersonal skills.
Intermediate computer skills (including MS Office and Outlook), ability to learn new applications.
Strong analytical skills.
Ability to multi-task.
Ability to work both independently and in a team environment.
Ability to work in a dynamic, fast-paced environment.
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.ElevanceHealthinc.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.
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Email us (elevancehealth@icareerhelp.com) or call 1-877-204-7664