Medical Director - Post Acute Care

Position Overview

Carelon Medical Benefits Management, a proud member of the Elevance Health family, is seeking a Clinical Operations Medical Director to support timely and consistent medical decisions in Post Acute Care Benefit Utilization Management. This role offers both part-time and full-time options, with schedules of 10:00AM-7:00PM CT on weekdays and 7:00AM-4:00PM CT on one required weekend day. Virtual work is enabled with required in‐person training sessions, though candidates must be within a reasonable commuting distance unless an accommodation is provided by law.

Key Responsibilities

• Ensures timely completion of clinical case reviews for the board certified specialty.
• Makes physician-to-physician calls to gather medically appropriate information for determining medical necessity.
• Makes medical necessity determinations for grievance and appeals.
• Ensures consistent application of company medical policies when making decisions.
• Escalates cases requiring Medical Director review or policy interpretation to supervisors.

Required Qualifications

• MD/DO with Board certification approved by ABMS or AOA, as applicable.
• Active, unrestricted medical license to practice medicine or a health profession.
• Minimum of 1 year of experience with clinical case reviews for medical necessity (waived for specialties in Cardiology, Oncology, or Interventional Pain).
• Board certification in a medical specialty.

Preferred Qualifications

• Three years of clinical experience post-residency, preferably in inpatient post-acute care.
• Board certification in Physical Medicine and Rehabilitation is preferred.

Benefits & Perks

• Compensation: Salary range of $179,503 to $307,732, based on geographic location, experience, education, and skills.
• Comprehensive benefits package including medical, dental, vision, short and long term disability benefits.
• Additional rewards: Incentive and recognition programs, equity stock purchase, 401(k) contribution, paid holidays, and Paid Time Off.
• Flexible work environment with virtual work options and a hybrid workforce strategy.
• Positions available in California, Illinois, Nevada, and Washington State.