Anticipated End Date:2026-09-25
Position Title:Associate Medical Director- DMEPOS
Job Description:Clinical Operations Associate Medical Director Carelon Medical Benefits ManagementDMESchedule: 8-5 Central Time Monday-Friday
Virtual: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development.
Alternate locations may be considered if candidates reside within a commuting distance from an office.- Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.
The
Clinical Operations Associate Medical Director- DMEPOS will be responsible for supporting the medical management staff ensuring timely and consistent medical decisions to members and providers primarily regarding DME.
How you will make an impact:- 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.
Minimum Requirements: Requires MD/DO and board certification approved by one of the following certifying boards is required, where applicable to duties being performed, American Board of Medical Specialties (ABMS) or American Osteopathic Association (AOA). Must possess an active unrestricted medical license to practice medicine or a health profession.
Preferred Skills, Capabilities and Experiences:- Board certification in Family Medicine, Internal Medicine, or PM&R preferred.
- Additional State Licensure may be required to obtain after hire
Job Level:Non-Management Non-Exempt
Workshift:Job Family:MED > Licensed Physician/Doctor/Dentist
Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
