Associate Medical Director - Genetic Testing UM

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.

• 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.

• MD or 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.

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution
• Life insurance
• Wellness programs
• Financial education resources

A proud member of the Elevance Health family of companies, Carelon Medical Benefits Management, formerly AIM Specialty Health, is a benefit-management leader in Illinois. Our platform delivers significant cost-of-care savings across an expanding set of clinical domains, including radiology, cardiology and oncology.