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Associate Medical Director, Pharmacy Benefits Prior Authorization (Remote)

Company: Elevance Health
Location: Santa Fe
Posted on: November 22, 2022

Job Description:

Associate Medical Director, Pharmacy Benefits Prior Authorization (Remote)

  • Job Family: Medical and Clinical
  • Type: Full time
  • Date Posted:Oct 11, 2022
  • Req #: JR29132Location:
    • IL, Chicago
    • NV, Las Vegas
    • Minnesota, Minneapolis
    • NJ, Morristown
    • Florida, Ft. Lauderdale
    • CT, Wallingford
    • WI, Madison
    • IN, Indianapolis
    • VA, Virginia Beach
    • MO, St. Louis
    • National +50 Miles away from nearest PulsePoint, National +50 Miles away from nearest PulsePoint
    • TX, Fort Worth
    • CA, Sacramento
    • OH, Columbus
    • KY, Louisville
    • CA, Los Angeles
    • MA, Boston
    • NH, Manchester
    • NY, New York
    • TX, Houston
    • Connecticut, Hartford
    • AZ, Phoenix
    • NE, Norfolk
    • MN, Mendota HeightsDescriptionA proud member of the Elevance Health family of companies, IngenioRx leverages the power of new technologies and a strong, clinical-first lens, to deliver member-centered, lasting pharmacy care.Our Associate Medical Director is responsible for providing day-to-day guidance, support, and leadership for IngenioRX (Pharmacy Benefit Manager) , under the guidance of a Medical Director. S/he may be responsible for supporting one or more Medical Directors in ensuring the clinical integrity of broad and significant clinical programs. S/he will perform clinical reviews of prior authorization prescription benefit or drug benefit cases for the PBM's Commercial and Medicaid business.[This role can work remotely from anywhere in the US]Primary duties may include, but are not limited to: May provide clinical guidance for programs. Supports clinicians to ensure timely and consistent responses to members and providers. Conducts peer-to-peer clinical reviews with attending physicians or other ordering providers to discuss review determinations, and patients office visits with providers and external physicians. May conduct peer-to-peer clinical appeal case reviews with attending physicians or other ordering providers to discuss review determinations. May participate in a physician on-call rotation for a 24x7 unit. May assist in the practitioner appeal reviews, appropriateness criteria reviews, medical technology assessments, setting and implementing QI initiatives, and practitioner/provider credentialing. Under direction, may be responsible for the administration of medical services for company health plans including medical policies. Serves as a resource and consultant to other areas of the company. May interpret existing medical policy. May be required to represent the company to external entities and/or serve on internal and/or external committees.Requires 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. Minimum of 5 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.Highly preferred skills and experience:-Experience in a Pharmacy Benefits Management company-Experience with Utilization Management, Quality reviews, Prior Authorization request, or case reviews for medications and drug benefits.Applicable to Colorado Applicants OnlyAnnual Salary Range*: $208,000 - $261,000Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
      • The hourly or salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. The Company may ultimately pay more or less than the posted range. This range is only applicable for jobs to be performed in Colorado. This range may be modified in the future. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Companys sole discretion, consistent with the law.Please be advised that Elevance Health only accepts resumes from agencies that have a signed agreement with Elevance Health. Accordingly, Elevance Health is not obligated to pay referral fees to any agency that is not a party to an agreement with Elevance Health. Thus, any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.Be part of an Extraordinary TeamElevance Health is a health company dedicated to improving lives and communities and making healthcare simpler. Previously known as Anthem, Inc., we have evolved into a company focused on whole health and updated our name to better reflect the direction the company is heading.We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.The health of our associates and communities is a top priority for Elevance Health. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide and Elevance Health approves a valid religious or medical explanation as to why you are not able to get vaccinated that Elevance Health is able to reasonably accommodate. Elevance Health will also follow all relevant federal, state and local laws.Elevance Health has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 Worlds Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact for assistance.EEO is the LawEqual Opportunity Employer / Disability / VeteranPlease use the links below to review statements of protection from discrimination under Federal law for job applicants and employees.
        • EEO Policy Statement
        • EEO is the Law Poster
        • EEO Poster Supplement-English Version
        • Pay Transparency
        • Privacy Notice for California ResidentsElevance Health, Inc. is an E-verify EmployerNeed Assistance?Email us ( or call 1-877-204-7664

Keywords: Elevance Health, Santa Fe , Associate Medical Director, Pharmacy Benefits Prior Authorization (Remote), Healthcare , Santa Fe, New Mexico

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