Medical Director - Genetic Testing Oncology

at Elevance Health in Wilmington, Delaware, United States Job Description Medical Director -

Genetic Testing Oncology Location:

This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. 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 locations may be considered. The Medical Director - Genetic Testing Oncology is responsible for performing utilization case reviews in genetic testing with an oncology perspective. How you will make an impact: + Determines the medical necessity of requests using clinical criteria. + Performs physician-level case review of oncologic utilization requests. + Conducts peer-to-peer consultation with ordering physicians, physician assistants and advanced practice nurses regarding established guidelines and accepted standards of care as it relates to treatments, procedures, imaging and appropriate sites of service. + Provides education regarding applicable clinical criteria and discusses clinically appropriate options. + Performs first level provider appeals for coverage decisions. + Provides support and education to internal clinical and non-clinical staff regarding the principles associated with appropriate diagnoses, treatments, and management related to these specialties. + Participates in physician team meetings. + Participates in groups that develop, revise and enhance clinical appropriateness guidelines.

Minimum Requirements:

+ Requires MD and/or DO, completion of training in Oncology, or related board certification by either the American Board of Medical Specialties or the American Osteopathic Association Specialties. + Requires a current, valid, active and unrestricted medical license(s) as a Doctor of Medicine or Doctor of Osteopathic Medicine in appropriate state(s). + Requires a minimum of 5 years of clinical experience.

Preferred Qualifications:

+ Experience with utilization management, especially with CMS guidelines preferred. For candidates working in person or virtually in the below locations, the salary• range for this specific position is $ 291,200.00 to $ 524160.00. Location(s): •California, Illinois, To view full details and how to apply, please login or create a Job Seeker account