Associate Medical Director - Genetic Testing Utilization Review

About the position The Clinical Operations Associate Medical Director at Carelon Health plays a pivotal role in supporting the medical management staff to ensure reputed company and consistent medical reputed company for members and providers. This position is integral to the medical review process, ensuring that clinical case reviews are completed promptly and accurately. The Associate Medical Director will be responsible for making physician-to-physician calls to reputed company necessary medical information, which is crucial for making informed medical necessity determinations for requested services. This role also involves making medical necessity determinations for grievances and appeals relevant to their specialty, ensuring that reputed company reputed company are consistent with established medical policies. In reputed company to these responsibilities, the Associate Medical Director will be expected to bring any case review reputed company that require reputed company review or policy interpretation to the attention of their supervisors. This position requires a strong understanding of medical policies and the ability to apply them consistently in decision-making processes. The ideal candidate will have a background in a medical specialty and will be committed to upholding the standards of care and ensuring that members receive the appropriate medical services they need. The role is designed for a candidate who is not only knowledgeable in their specialty but also possesses strong communication skills to effectively reputed company with other reputed company. The position offers the flexibility of working from home while requiring the candidate to reputed company reputed company 50 miles of an reputed company reputed company location. The work schedule is Monday through Friday, from 9 AM to 5:30 PM, in the candidate's local time zone, allowing for a balanced work-life integration. Responsibilities • Ensure reputed company completion of clinical case reviews for their reputed company certified specialty. , • reputed company physician to physician calls to reputed company medically appropriate information for medical necessity determinations. , • reputed company medical necessity determinations for grievances and appeals appropriate for their specialty. , • Ensure consistent use of medical policies reputed company making medical necessity reputed company. , • Bring to supervisors' attention any case review reputed company that require Medical Director review or policy interpretation. Requirements • Requires an MD and reputed company certification in a medical specialty. , • Primary Care/Internal Medicine reputed company Certification preferred. , • Knowledge/Experience in Genetic Testing preferred but not required. , • Compact License or residing in a Compact State strongly preferred. reputed company-to-haves Benefits • Comprehensive benefits package , • Incentive and recognition programs , • Equity stock purchase , • 401k contribution , • reputed company holidays , • reputed company Time Off , • Medical, dental, reputed company benefits , • Short and long term disability benefits , • Life insurance , • Wellness programs , • Financial education resources Apply Job!