About the position The Medical Director-Appeals role at Elevance Health is a hybrid position focused on overseeing appeal reviews for physical health medical services. The primary responsibility is to ensure that members receive appropriate and cost-effective medical care. The role involves developing and implementing programs aimed at improving quality, cost, and outcomes, as well as providing clinical consultation and serving as a strategic advisor to enhance clinical operations. The Medical Director may also identify cost of care opportunities and serve as a resource for staff, including Medical Director Associates. Responsibilities Conduct appeal reviews for physical health medical services. , Support clinicians to ensure timely and consistent responses to members and providers. , Provide guidance for clinical operational aspects of a program. , Conduct peer-to-peer clinical appeal case reviews with attending physicians or other ordering providers. , Serve as a resource and consultant to other areas of the company. , Represent the company to external entities and/or serve on internal and/or external committees. , Chair company committees as needed. , Interpret medical policies and clinical guidelines. , Develop and propose new medical policies based on changes in healthcare. , Lead, develop, direct, and implement clinical and non-clinical activities that impact healthcare quality, cost, and outcomes. , Identify and develop opportunities for innovation to increase effectiveness and quality. Requirements MD or DO with Board certification approved by ABMS or AOA. , Active unrestricted medical license to practice medicine or a health profession. , Minimum of 10 years of clinical experience or equivalent education and experience. , For Health Solutions and Carelon organizations, minimum of 5 years of experience providing healthcare is required. Nice-to-haves Board certification in Internal or Family medicine strongly preferred. , Florida medical license or the ability to obtain once hired strongly preferred. Benefits Merit increases , Paid holidays , Paid Time Off , Incentive bonus programs , Medical, dental, and vision benefits , Short and long term disability benefits , 401(k) with matching , Stock purchase plan , Life insurance , Wellness programs , Financial education resources Apply Job!