## Medical Director – Physical Medicine and Rehabilitation

Anticipated End Date: 2026-07-17

This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. Alternate location may be considered.

You will join the Home Care (HC) Durable Medical Equipment (DME) team, which is responsible for reviewing high-cost DME requests. The Medical Director focuses on evaluating cases to determine the appropriateness of services, particularly within a Medicaid context. You will collaborate with a small, distributed team operating across multiple states and must be comfortable working cross-functionally and communicating effectively.

You will support clinicians to ensure timely and consistent responses to members and providers and provide guidance for clinical operational aspects of a program. The role involves conducting peer-to-peer clinical reviews with attending physicians or other providers to discuss review determinations, including patients’ office visits with providers and external physicians. You may also conduct peer-to-peer clinical appeal case reviews with attending physicians or other ordering providers to discuss review determinations.

As a resource and consultant across the company, you may be required to represent the company to external entities and/or serve on internal and/or external committees and may chair company committees. You will interpret medical policies and clinical guidelines and may develop and propose new medical policies based on changes in healthcare. The role leads, develops, directs, and implements clinical and non-clinical activities that impact health care quality, cost, and outcomes, and identifies and develops opportunities for innovation to increase effectiveness and quality.

Minimum Requirements:

- 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.

- Unless expressly allowed by state or federal law, or regulation, must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US military base, vessel or any embassy located in or outside of the US.

- Minimum of 10 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.

- For Health Solutions and Carelon organizations (including behavioral health) only, minimum of 5 years of experience providing health care is required.

- Additional experience may be required by State contracts or regulations if the Medical Director is filing a role required by a State agency.

Preferred Qualifications:

Utilization management (UM) experience preferred. Board certification in Physical Medicine and Rehabilitation strongly preferred.

Compensation and locations:

For candidates working in person or virtually in the below locations, the salary\* range for this specific position is $247,840.00 to $446112.00. Location(s): California, Illinois, Maryland, Massachusetts, New Jersey, New York, and Columbus, OH.

In addition to your salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.

The 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. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education, and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is 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 Company’s sole discretion, consistent with the law.

Other notes about the role and company:

This role is Job Level: Director Equivalent and Workshift: 1st Shift (United States of America). The job family is MED > Licensed Physician/Doctor/Dentist. Elevance Health is a health company dedicated to improving lives and communities and operates a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

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 should submit the Accessibility Accommodation Request Form.

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.