Additional Information
Anticipated End Date:
2026-06-15
Position Title:
Specialist Medical Director - Cardiology
Job Description:
Clinical Operations Medical Director Specialist
Carelon Medical Benefit Management
Cardiology Specialty
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.
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.
Carelon, a proud member of the Elevance Health family of companies, is a healthcare services organization that takes a whole-health approach to making care more integrated, personalized, and affordable. We put people at the center-connecting physical, behavioral, social, and pharmacy services, along with clinical expertise, research, operations, and advanced technology to help care work better, together.
Among us are specialty-care physicians, nurse practitioners, pharmacists, engineers, data scientists, and other dedicated and caring health professionals. While our roles may differ, our purpose is shared: to make a positive impact on whole health.
The Clinical Operations Medical Director is responsible for performing pre-authorizations and providing quality improvement solutions involving cardiovascular procedures and requests for oncologic treatment (medical or radiation) including future expansions.
How you will make an impact:
Determines the medical necessity of requests using clinical criteria.
Performs physician-level case review of cardiovascular or oncologic utilization requests.
Conducts peer-to-peer consultation with ordering physicians, physician assistants and advanced practice nurses regarding established guidelines and accepted standards of care as it relates to treatments, procedures, imaging and appropriate sites of service.
Provides education regarding applicable clinical criteria and discusses clinically appropriate interventional and non-interventional options.
Performs first level provider appeals for coverage decisions.
Provides support and education to internal clinical and non-clinical staff regarding the principles associated with appropriate diagnoses, treatments, and management related to these specialties.
Participates in physician team meetings.
Participates in groups that develop, revise and enhance clinical appropriateness guidelines.
Minimum Requirements:
Requires MD and/or DO, completion of training in Cardiology, Oncology, or related board certification by either the American Board of Medical Specialties or the American Osteopathic Association Specialties.
Requires a current, valid, active and unrestricted medical license(s) as a Doctor of Medicine or Doctor of Osteopathic Medicine in appropriate state(s).
Requires a minimum of 5 years of clinical experience.
Preferred Skills, Capabilities, and Experiences:
Experience with utilization management, especially with CMS guidelines preferred.
Board certification in Cardiology strongly preferred.
Job Level:
Director Equivalent
Workshift:
1st Shift (United States of America)
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.
Elevance Health (anthem) · Indianapolis, 220 Virginia Ave, IN